Radiological Category Gastrointestinal Principal Modality 1 General Radiography

Case History 47 year old hispanic male with 4 day history of increasing abdominal

Test Your Diagnosis Which one of the following is your choice for the appropriate

Findings and Differentials Findings: Multiple gas dilated loops of small and large bowel. A

Discussion The presence of dilated loops of large bowel argues against a small bowel

Discussion Sigmoid volvulus is the most common volvulus in adults and is responsible for

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Radiological Category: Gastrointestinal Principal Modality (1): General Radiography Principal Modality (2): CT Case Report #0235 Submitted by: Kenneth Bryant, M. D. , Ph. D. Faculty reviewer: Chitra Chandrasekhar, M. D. Date accepted: 31 July 2005

Case History 47 year old hispanic male with 4 day history of increasing abdominal pain and distension. The pain started shortly after an iron beam fell across his abdomen. No prior history of abdominal surgery.

Radiological Presentations

Test Your Diagnosis Which one of the following is your choice for the appropriate diagnosis? After your selection, go to next page. • Small Bowel Obstruction • Intussusception • Sigmoid Volvulus • Cecal Volvulus

Findings and Differentials Findings: Multiple gas dilated loops of small and large bowel. A small amount of stool is noted in the right lower quadrant and may represent stool in the ascending colon or fecalization in the small bowel. No free air under the diaphragm to suggest perforation. Differentials: • Sigmoid Volvulus • Cecal Volvulus • Small bowel obstruction

Discussion The presence of dilated loops of large bowel argues against a small bowel obstruction. On further inspection of the radiographs one can see the “coffee bean” sign consistent with sigmoid volvulus. This is shown on the following radiograph.

Radiological Presentations

Discussion Sigmoid volvulus is the most common volvulus in adults and is responsible for 8% of all colonic obstructions. It occurs in the elderly and in patients with chronic constipation or high fiber diets, so that a redundant sigmoid colon can rotate upon its mesenteric axis. No definite literature was found linking volvulus after blunt abdominal trauma. The following shows select images from a CT scan of the abdomen and pelvis in reverse order. It is best to follow the rectum up and notice the rotation of the sigmoid colon. The patient was decompressed by sigmoidoscopy and had elective resection several days later.

Radiological Presentations

Diagnosis Sigmoid Volvulus