Presentation
Severe abdominal pain, abdominal distension and absence of bowel motion for one week duration.
Patient Data
No air under diaphragm on erect chest radiograph.
AP supine abdominal radiograph.
- Grossly dilated large bowel loops. Reminiscent of "Coffee bean sign" at left side of abdomen.
- Frimann-Dahl sign - three dense lines (sigmoid walls) converging to the pelvic region/site of obstruction with empty rectal gas.
- Absence of rectal gas.
Gross dilatation of large bowel loops (from cecum till distal sigmoid colon).
The transition point is at the sigmoid colon (left iliac fossa) where bird beak sign noted (rectal contrast administered) - tapering of the sigmoid colon.
Whirl sign noted at the adjacent mesocolon as well as the small bowel mesentery vessels.
No bowel related mass or abnormal bowel wall thickening.
No pneumoperitoneum, intramural gas and portal venous gas.
Minimal ascites at the pelvis.
Annotated images show the radiographic signs for sigmoid volvulus.
Case Discussion
Overall imaging features are in keeping with sigmoid volvulus without evidence of bowel ischemia.
Emergency laparotomy performed.
Intraoperative findings:
- Grossly dilated sigmoid colon until cecum
- sigmoid colon twisted for 350 degrees on mesocolon.
- Cecum healthy.
- Minimal ascites.
- Redundant sigmoid colon resected with primary anastomosis.
*Image courtesy of Dr Nurliyana Izyan Binti A Halim (Radiology department,Hospital Ampang, Malaysia)
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