- © 2008 Canadian Medical Association
An 85-year-old man with a history of tongue cancer presented to the emergency department with a 2-day history of abdominal distension, pain and constipation. He had no fever or vomiting. A physical examination revealed a distended abdomen with decreased bowel sounds. A plain radiograph of the abdomen showed a markedly distended sigmoid loop with an inverted U-shape (Figure 1), also known as the “coffee-bean sign,” consistent with sigmoid volvulus. A rubber drain tube was inserted through the rectum for decompression by use of a fiberscope.
Sigmoid volvulus is a potentially life-threatening condition. It is the third most common cause of colonic obstruction after cancer and diverticulitis, and it accounts for about 8% of intestinal obstructions. Proposed causes include anatomic variation, chronic constipation, neurologic disease and megacolon. Clinical presentation includes abdominal bloating, pain, vomiting, constipation and peritonitis.1 Conservative treatment options include decompression under fluoroscopy or endoscopy, and surgery may be required for failed decompression, recurrent volvulus or bowel ischemia.2
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Competing interests: None declared.