Sigmoid volvulus: failed rectal tube decompression

Case contributed by Chris O'Donnell
Diagnosis certain

Presentation

Abdominal pain and distension. Failed improvement following insertion of a rectal tube, ? cecal volvulus

Patient Data

Age: 90
Gender: Female

Rectal tube tip (arrow) sits distal to the whorled appearance (arrow) in the sigmoid mesocolon with abrupt transition in colonic caliber (arrow) indicative of sigmoid volvulus

Case Discussion

The rectal tube must be passed beyond the volved segment in order to decompress the bowel. It is usually very apparent to the operator at the time if the procedure is successful as marked gas and copious fecal material erupts from the tube and often around it along the rigid sigmoidoscope!

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