This post is an answer to the Case – Sudden Severe Colicky Abdominal Pain, Vomiting and Constipation
Interpretation
- Massively distended bowel with inverted U-shaped configuration – representing a grossly dilated sigmoid colon.
- ‘Coffee-bean sign’ – distinct midline crease between the distended loop. It represents the two bowel walls in contact.
- Inferior convergence sign – the two limbs of the loop converge inferiorly, pointing to the left lower quadrant.
Diagnosis
Supine abdominal radiograph shows grossly dilated sigmoid colon (arrows) with the ‘coffee bean’ sign (arrowheads) and inferior convergence sign of sigmoid volvulus (open arrows).
Key Points
- Abdominal radiograph is the initial investigation for suspected sigmoid volvulus.
- Distended loop of bowel with inverted U-shaped confi guration and coffee bean appearance are characteristic radiological features of sigmoid volvulus.
- Immediate treatment with rectal tube insertion is indicated to untwist the volvulus to prevent further bowel ischaemia/ necrosis.
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