Sigmoid volvulus with therapeutic rectal enema

Case contributed by Dr Jörgen Strömberg

Presentation

Male patient presenting with a history of slowly progressing abdominal pain for the last five days. No previous surgery. Clinical examination reveals abdominal swelling and fever (38.5ºC).

Patient Data

Age: 50 years old
Gender: Male

The CT examination shows a markedly dilated colon. The rectum however is not dilated. The point of transition seems to be a mesenteric swirl at the level of the promontorium. This is best appreciated on the coronal series.

Somewhat confusingly, in this case the sigmoid loop is found in the right side of the abdomen, lateral to the cecum which has been relocated to the midline and actually slightly to the left.

Subsequent barium enema shows the characterestic beak sign, localized at the same point as the mesenteric swirl. Once this point could be passed, there was an instant evacuation of feces and gas from up to obstructed sigmoid.

Subsequent barium enema shows the characterestic beak sign, localized at the same point as the mesenteric swirl. Once this point could be passed, there was an instant evacuation of faeces and gas from upto the obstructed sigmoid.

Case Discussion

The CT findings are classic for a sigmoid volvulus: Dilated sigmoid and proximal colon, and a mesenteric swirl corresponding to the axis around which the sigmoid has twisted. The subsequent barium enema shows the characteristic beak sign.

This patient recovered promptly, and returned home a couple of days after undergoing this therapeutic procedure - one of the rare opportunities a classic radiologist is given to actually cure his patients. 

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Case information

rID: 42857
Case created: 11th Feb 2016
Last edited: 18th Jul 2016
Inclusion in quiz mode: Included

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