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Sigmoid volvulus with whirl sign

Case contributed by Andrei Dumitrescu
Diagnosis certain

Presentation

Elderly male patient presenting with prolonged obstipation, not having passed stool for a week, and increasing abdominal pain.

Patient Data

Age: 75 years
Gender: Male

Torsion of the sigmoid and its mesenterium with whirl sign. Massive distension of the proximally situated sigmoid up to 8 cm in diameter. Coprostasis of the colon in keeping with large bowel obstruction. Oral contrast in the small bowel, which is not pathologically distended. There is no fecalization of the distal small bowel.  

Case Discussion

CT is the imaging modality of choice in cases of suspected bowel obstruction. This is a classic presentation of sigmoid volvulus with the so called whirl sign due to torsion of the sigmoid and its mesentery. Therapy consisted of a decompressive colonoscopy.

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