Presentation
Left sided abdominal pain with recurrent vomiting for one day, background history of chronic constipation.
Patient Data
Supine abdominal radiograph showed coffee bean shape appearance of dilated large colon which is relatively lack of haustration. Absent rectal gas.
No pneumoperitoneum in abdominal radiograph and erect chect radiograph.
Grossly distension of the sigmoid colon with gas-fluid levels, lacking haustra forming a closed-loop obstruction. The transition point is at the distal sigmoid colon,measuring 25cm from the anal verge (external anal sphincter). Two points of obstruction noted at this transition point.
Case Discussion
Imaging features are in keeping with sigmoid volvulus, which was confirmed with intra-operative findings. X-marks-the-spot sign improves the diagnostic confidence of sigmoid volvulus. It usually indicates complete volvulus rather than partial volvulus.
Patient went on for explaratory and sigmoid colectomy with side to side anastomosis.
Intraoperative findings:
Hugely dilated sigmoid colon
Needle decompression done using 21 Gauge needle, however, sigmoid colon was very redundant and dilated in caliber, decided for sigmoid colectomy.
Twisted 2 times at mesocolic axis
Axis of volvulus entrapped by adhesion band of omentum to left lateral abdominal wall-released
Distal to obstruction, no mass felt.