Presentation
Abdominal distension, vomiting, constipation, severe pain and bleeding per rectum
Patient Data
Marked distention of small & large bowel with gas & fluid producing multiple air-fluid levels matching with intestinal obstruction. A twist is seen involving the sigmoid colon. On rectal CT contrast enema, the contrast flow ceases at this twist creating "bird beak sign". Twisting of the mesentery and mesenteric vessels at this point is also noted "whirl sign".
The diagnosis of sigmoid volvulus was confirmed on laparotomy. The sigmoid colon was very redundant so the selected operative technique was sigmoidectomy, Hartmann procedure, and end colostomy. Postoperative CT study follow up before the revision of colostomy shows postoperative changes with no evidence of obstruction.
Case Discussion
Sigmoid volvulus is a cause of large bowel obstruction and occurs when the sigmoid colon twists on its mesentery. Symptoms are that of large bowel obstruction: constipation, abdominal bloating, nausea, and vomiting. Common causes are chronic constipation, laxative abuse, fiber-rich diet, and Chagas disease. In this case, the patient gave a history of chronic laxatives use.
Some surgeons consider that sigmoid volvulus is exclusively seen in the elderly, however, radiologists shouldn't do. Once imaging findings are straightforward for sigmoid volvulus, go on to your diagnosis regardless of the patient's age.
Unable to process the form. Check for errors and try again.