48 year-old male presents to the er with abdominal
TRANSCRIPT
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48 year-old male presents to the
ER with abdominal distention and
pain.Ryan Joyce, MD
Mark Kane, MD
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?
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Sigmoid
volvulus
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Dilated colonic loops with multiple air-fluid levels
demonstrated on upright radiograph
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Relative paucity of rectal gas, suspicious for
distal large bowel obstruction
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Proximal to transition point, dilated colonic loops
with multiple air-fluid levels
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Transition point going into the volvulus
Aka colonic beaking
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Classic “whirl” sign of the colon and mesentery
Best visualized on coronal reformatted images
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Classic “whirl” sign of the colon and mesentery
Best visualized on coronal reformatted images
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Classic “whirl” sign of the colon and mesentery
Best visualized on coronal reformatted images
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Classic “whirl” sign of the colon and mesentery
Best visualized on coronal reformatted images
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Classic “whirl” sign of the colon and mesentery
Best visualized on coronal reformatted images
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Classic “whirl” sign of the colon and mesentery
Best visualized on coronal reformatted images
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Classic “whirl” sign of the colon and mesentery
Best visualized on coronal reformatted images
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Classic “whirl” sign of the colon and mesentery
Best visualized on coronal reformatted images
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Classic “whirl” sign of the colon and mesentery
Best visualized on coronal reformatted images
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Classic “whirl” sign of the colon and mesentery
Best visualized on coronal reformatted images
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Classic “whirl” sign of the colon and mesentery
Best visualized on coronal reformatted images
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Classic “whirl” sign of the colon and mesentery
Best visualized on coronal reformatted images
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Classic “whirl” sign of the colon and mesentery
Best visualized on coronal reformatted images
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Inverted U sign
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Distally, decompressed rectum
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Sigmoid volvulus with mechanical
large bowel obstructionTorsion and twisting of sigmoid colon around its mesenteric axis with resultant obstruction.
Imaging:– Coronal reformatted CT is especially useful in diagnosis, as
demonstrated in this case.
– Signs: inverted “U”, “whirl” sign, colonic beaking.
Epidemiology:– 3rd most common cause of colonic obstruction.
– 1-2% of intestinal obstructions in the US.
– Increased incidence in elderly men, and residents of nursing homes or mental hospitals (more constipation and obtundation in these populations).
– Frequent comorbid psychiatric disease.
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Sigmoid volvulus with mechanical
large bowel obstructionPresentation:• Acute or insidious onset abdominal pain, vomiting, distention, and
obstipation.
• Complications:– Closed loop obstruction with strangulation, ischemia, necrosis, perforation.
Poor prognosis. Uncomplicated cases have a good prognosis.
Treatment:• Initial: sigmoidoscopic decompression of obstruction, usually with
stabilization via rectal tube insertion.
• Sometimes followed by surgical resection of sigmoid colon.– 40-50% recurrence after nonoperative tx.
– 3% recurrence after operative tx.
– Complicated cases are a surgical emergency.
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References
1. Jaffe, T., Thompson, W.M. Large-bowel obstruction in the adult:
Classic radiographic and CT findings, etiology, and
mimics. Radiology. 2015;275:651–663
2. Peterson, C., Anderson, J., Hara, A., Carenza, J., Menias,
C. Volvulus of the gastrointestinal tract: appearances at multi-
modality imaging. Radiographics. 2009;29:1281–1293.
3. Maddah G et al: Management of sigmoid volvulus: options and
prognosis. J Coll Physicians Surg Pak. 24(1):13-7, 2014
4. Statdx.com