33 Sigmoid volvulus
Fig. 33.1A This radiograph demonstrates a large gas-filled loop of bowel, arising from the left iliac fossa and pointing to the liver. It has a central sulcus giving it a coffee bean appearance. This is a sigmoid volvulus. The calcified densities in the pelvis are due to fibroids.
Background
This is a cause of large bowel obstruction, which results from the twisting of a long, redundant loop of sigmoid colon on its mesentery, causing proximal obstruction. It has a quite distinctive appearance on the plain radiograph, which is essential in the diagnostic pathway.
Patients with a long redundant sigmoid colon are at risk. These groups include elderly psychiatric patients and patients with chronic constipation who have been on long-term laxatives.
Clinical features
These can be rather non-specific but the condition can also present with acute large bowel obstruction – abdominal pain and a tympanic distended abdomen.
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