Absolute constipation caused by sigmoid volvulus in a young man

Abstract

We describe a challenging case of sigmoid volvulus where a previously unrecognised anatomical condition, rather than the patient's age, was the main predisposing factor. A man in his thirties presented to the emergency department with a 3-day history of constipation and acute abdominal pain. Initial assessment and studies were inconclusive, but a CT scan revealed torsion of the large bowelSigmoid volvulus is a frequent cause of bowel obstruction that can be missed if appropriate imaging is not available. Clinical presentation and blood analysis can be similar to the findings in acute abdomen caused by other more common causes.

Figure 1

Erect abdominal x-ray image shows gross dilatation of the colon with apposition of the medial walls and the presence of air/fluid.

Figure 2

Coronal CT image reveals a very dilated colonic loop extending from the pelvis to the left hypochondrium, with the characteristic inverted U loop or coffee bean appearance.

Figure 3

Axial CT slice showing the ‘bird beak’ sign (arrow) formed by tapering of the converging sections of the looped obstruction at the site of the torsion, with proximal bowel dilatation.

Figure 4

Coronal CT image showing the ‘whirl’ sign (arrow) indicating the twisted colon and mesentery.