Presentation
Constipation, abdomen distention and discomfort
Patient Data
Anteroposterior radiograph of the abdomen demonstrates the coffee bean sign in sigmoid volvulus. The coffee bean is formed by dilated loops of bowel with a radiopaque central cleft between the loops. There is also an air-fluid level in the dilated descending colon.
Contrast-enhanced axial CT shows a grossly distended colon with air-fluid level proximal to a beak-shaped transition point at the sigmoid-descending colon junction point.
We also note that afferent and efferent bowel loops rotate around a fixed point of obstruction leading twisted mesentery along the axis of rotation (whirl sign).
Annotated image and drawing show the split-wall sign caused by apparent separation of sigmoid walls by adjacent twisted mesenteric fat 1.
Case Discussion
The case shows classic CT Findings of sigmoid volvulus. The whirl sign is suggestive of intestinal volvulus 2.
The patient was succesfully treated by endoscopical decompression.