Sigmoid volvulus complicated by bowel ischaemia

Case contributed by RMH Core Conditions

Presentation

Small bowel obstruction.

Patient Data

Age: 80
Gender: Male

There is extensive distension of the colon, which measures up to 10 cm in diameter at the caecum. This extends to just distal to the rectosigmoid anastomosis, where there is a swirled appearance to the residual rectum suggesting volvulus.

No pneumoperitoneum or free fluid. Gas outlining the bowel wall of the caecum to hepatic flexure represents gas against faecal matter. No portal venous gas.

Whilst the majority of the colon, including the caecum demonstrates normal mural enhancement the distal sigmoid colon and immediately proximal to the rectosigmoid anastomosis ( for a length of approximately 5 cm ) shows no or minimal mural enhancement raising the possibility of distal sigmoid ischaemia.

There is mild faecalisation of the distal small bowel, otherwise the small bowel is normal. A nasogastric tube has been inserted, with the tip in the mid duodenum.

A 2.5 x 1.5 cm water density subcutaneous lesion is seen just superior to the umbilicus, possibly a seroma related to the previous laparotomy incision. Bilateral renal cysts again noted, the largest measuring 7.5 cm and the right kidney lower pole. The prostate is enlarged, measuring 6.1 x 5.5 x 6.0 cm. The liver, spleen, pancreas, gallbladder and adrenals are unremarkable.

Conclusion:

Large bowel obstruction just distal to the rectosigmoid anastomosis secondary to rectosigmoid volvulus. The caecum is at risk of ischaemia given and it is distended to 10 cm. There are imaging findings suggestive of ischaemia of the distal portion of the sigmoid immediately proximal to the rectosigmoid anastomosis, as outlined above. No evidence of perforation.

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Case Information

rID: 30302
Case created: 1st Aug 2014
Last edited: 23rd Nov 2016
Tag: dls
Inclusion in quiz mode: Included

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