What does sigmoid volvulus look like?

Sigmoid volvulus – ‘coffee bean’ sign The sigmoid colon is very dilated because it is twisted at the root of its mesentery in the left iliac fossa (LIF). The proximal large bowel is also dilated (asterisks). The twisted loop of sigmoid colon is said to resemble a coffee bean.

What is the sigmoid volvulus?

Pathophysiology — Sigmoid volvulus occurs when an air-filled loop of the sigmoid colon twists about its mesentery. Obstruction of the intestinal lumen and impairment of vascular perfusion occur when the degree of torsion exceeds 180 and 360 degrees, respectively [24].

How do you identify a sigmoid volvulus?

Plain abdominal radiographic findings are usually diagnostic of sigmoid volvulus. Decompression may be achieved by the introduction of a stiff tube per rectum, aided by endoscopy or fluoroscopy. A single-contrast barium enema examination is usually adequate if it is required, as in cases when the diagnosis is in doubt.

How does sigmoid volvulus occur?

Sigmoid volvulus is the most common type of colonic volvulus and occurs when a portion of the intestine twists around its blood supply. In sigmoid volvulus, this occurs at the base of the mesentery. It most commonly presents in patients who are bedbound and have a history of chronic constipation.

Is sigmoid volvulus an emergency?

Sigmoid volvulus is a serious surgical emergency and a common cause of large bowel obstruction in India. Patients present with abdominal pain, distension and obstipation and abdominal skiagram usually reveals the characteristic omega sign.

Why is sigmoid volvulus common?

Sigmoid volvulus may occur because of sigmoid elongation, resulting in a redundant loop. Most commonly, this is the result of chronic constipation and the progressive dilatation and lengthening of the sigmoid colon and its mesentery.

How can you tell the difference between sigmoid and cecal volvulus?

A definitive sign of a cecal volvulus is the upward displacement of the appendix with obstruction of the large bowel. Comparatively, a sigmoid volvulus will show findings of a bent inner tube sign with the apex of the volvulus located in the left upper quadrant.

What is an example of a massive sigmoid volvulus?

This case provides an excellent example of a massive sigmoid volvulus with classic imaging findings. A sigmoid volvulus arises in the pelvis from the left lower quadrant, often with a “coffee-bean” sign present. Because the sigmoid colon rotates around its mesentery, this creates a whirling pattern of the vessels at the base of the mesentery.

How is the decompression of sigmoid volvulus guided?

The decompression of the sigmoid volvulus can be guided through endoscopy or fluoroscopy. It is important to understand that the acute sigmoid volvulus is a medical emergency and that it should be treated as such. The risk of complications is quite high with the acute onset of the sigmoid volvulus.

How is sigmoid volvulus diagnosed?

The diagnosis of sigmoid volvulus can be made based on the following investigations: X-ray The abdominal X-ray can identify the site of the problem with specific signs, such as the coffee bean sign or the absence of rectal gas Key radiologic feature – double-loop obstruction (present in 50% of all the patients) Fluoroscopy/ barium enema examination

How common is sigmoid volvulus in the elderly?

Sigmoid Volvulus in the Elderly Nearly 1/3 of elderly patients have a history of SV attack, and 50%–85% have serious co-existing diseases. SV may be preceded by inactivity and pseudomegacolon. Diagnosis is often difficult due to psychiatric problems and chronic illness.