Sigmoid volvulus and large bowel obstruction

Case contributed by Dr Varun Babu

Presentation

Non specific abdominal pain, vomiting and abdominal distension

Patient Data

Age: 50 years
Gender: Male
X-ray

Abdomen frontal radiograph

Raised intra abdominal pressure secondary to gaseous distension of small and large bowel suggestive of a distal large bowel obstruction. Patient was prepared for a CT. 

CT

CT abdomen and pelvis with oral positive and i.v. iodinated contrast.

CT confirms the findings of a distal large bowel obstruction. Whirlpooling of mesentery of the sigmoid colon with a clear transition zone is identified in the rectosigmoid. Proximal to it there is coffee bean like distension of the large bowel, accumulation of feces in small bowel, all in keeping with an ongoing large bowel obstruction. There is no features of bowel ischaemia. Mesenteric vessels are patent. No free intraperitoneal air. 

Case Discussion

There was no hesitation to immediately take up the patient for surgery and detorsed. Thankfully the involved segment of bowel was not ischaemic, and a sigmoidopexy and mesenteric plication was done. 

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Case information

rID: 46103
Case created: 21st Jun 2016
Last edited: 29th Nov 2016
Inclusion in quiz mode: Included

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