Sigmoid volvulus with subsequent therapeutic barium enema

Case contributed by Dr Jörgen Strömberg

Presentation

This patient arrived to the ER with a history of abdominal pain and vomiting since two days. During the last 24 hours a mild fever had developed. Urine samples had indicated urinary tract infection (the patient had a catheter). Upon clinical examination the patient was found to have a tympanistic abdomen, tachycardia and low saturation. The clinical suspicion was that of septicemia - possibly secondary to a pyelonephritis.

Patient Data

Age: 67
Gender: Male

Non-contrast abdominal CT

Modality: CT

The CT examination shows a markedly dilated sigmoid loop, which reaches all the way up to the diaphragm. Both ends of the sigmoid loop merge at a mesenteric swirl, located at the level of the promontorium (best appreciated on the coronal series). The colon proximal to the sigmoid is not particularly dilated, nor is there any small bowel distension. There are small amounts of fluid adjacent to the liver and in the pelvis.

The topogram shows the classic presentation of a sigmoid volvolus on conventional x-ray examination.

Therapeutic barium enema

Modality: Barium

These images are from the subsequent rectal enema - see annotations corresponding to each image/series.

Case Discussion

The CT findings are classic for a sigmoid volvulus: A grossly dilated sigmoid running in a closed off loop, with both ends of the loop merging at a mesenteric swirl corresponding to the axis around which the sigmoid has twisted. The subsequent barium enema shows the characteristic beak sign. The enema is not only a diagnostic but also a therapeutic procedure - one of the rare opportunities a classic radiologist is given to actually cure his patients.

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Case Information

rID: 43662
Case created: 20th Mar 2016
Last edited: 29th Sep 2016
Inclusion in quiz mode: Included

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