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Sigmoid Volvulus 1
Case Detail
| Anatomy: Gastrointestinal |
 Joseph Junewick, MD FACR |
| Diagnostic Category: Developmental or Congenital |
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| Created: about 1 year ago |
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| Updated: about 1 year ago |
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| Tags:
PEDS
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| Modality/Study Types:
CR
FL
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Activities:  PDF  ImageJA |
History
12 year old male with recurrent abdominal pain.
Case Images
Diagnosis
Sigmoid Volvulus
Findings
CR – Upright radiograph shows a markedly dilated loop of bowel in the low midline abdomen with air-fluid levels.
FL – Contrast opacifies the sigmoid colon with longitudinal twist clearly demonstrated.
Discussion
Sigmoid volvulus represents a closed loop obstruction that can result in bowel ischemia. It is usually an acquired condition seen in patients with chronic constipation who abuse laxatives but it is also seen in patients with conditions such as Parkinson disease, multiple sclerosis, Alzheimer disease, pseudobulbar palsy, schizophrenia, pregnancy, high fiber diets and Chagas disease. Clinical manifestations are abdominal pain, gradual or acute abdominal bloating, constipation, and vomiting although it is not uncommon for a patient to appear healthy despite dramatic bowel distention. In nearly half of all cases, there is a history of previous attacks. Differential diagnoses include pseudo-obstruction from laxatives or pain medications, distended transverse colon, cecal volvulus. Prompt decompression with a rectal tube or enema; surgical fixation decreases recurrence rate.
Reference
Feldman D. The coffee bean sign. Radiology (2000); 216:178-179.