scholarly journals A Symptomatic Coffee Bean: Acute Sigmoid Volvulus

2017 ◽  
Vol 11 (2) ◽  
pp. 348-351 ◽  
Author(s):  
Michael Scharl ◽  
Luc Biedermann
Keyword(s):  
Sigmoid Colon ◽  
Guide Wire ◽  
Outlet Obstruction ◽  
Primary Treatment ◽  
Sigmoid Volvulus ◽  
Coffee Bean ◽  
Diagnostic Colonoscopy ◽  
X Ray ◽  
Abdominal Emergency ◽  
Distended Abdomen

An acute sigmoid volvulus is due to the torsion of the sigmoid colon around its mesenteric axis. It mainly occurs in elderly patients and represents an abdominal emergency requiring urgent treatment. A 53-year-old male patient with severe craniocerebral injury and traumatic subarachnoidal bleeding 3 weeks prior presented on the ward with distended abdomen without abdominal pain, muscular defense, or resistances. He featured large volume diarrhea within the last few hours without signs of bleeding. A plain abdominal X-ray demonstrated a coffee bean sign indicating a sigmoid volvulus. A consequent CT scan of the abdomen revealed a deep outlet obstruction with massively dilated, elongated and twisted loop of the sigmoid colon and no signs of perforation. We performed emergency colonoscopy under the assumption of an acute sigmoid volvulus. After careful insertion of the endoscope completely refraining from insufflation of air or CO2, endoscopic reposition of the sigma could be achieved and a colonic drainage was placed over an inserted guide wire up to the proximal transverse colon. No relapse occurred and a diagnostic colonoscopy after 4 weeks revealed no tumor or polyps. Our report describes a classic case of acute sigmoid volvulus and undermines the potential of colonoscopy as conservative primary treatment of choice.

scholarly journals Volvulus with sigmoid necrosis in children: Two cases observed at Ignace Deen Hospital

2021 ◽  
Vol 9 (1) ◽  
pp. 028-031
Author(s):  
Fofana Houssein ◽  
Camara Soriba Naby ◽  
Keïta Karim ◽  
Fofana Naby ◽  
Soumaoro Labile Togba ◽  
...  
Keyword(s):  
Sigmoid Colon ◽  
Bowel Obstruction ◽  
Surgical Procedures ◽  
Clinical Observation ◽  
Sigmoid Volvulus ◽  
X Rays ◽  
Abdominal Emergency ◽  
Mechanical Bowel Obstruction ◽  
Male Patients ◽  
The Ideal

Introduction: We report the clinical observation of 2 cases of volvulus with sigmoid necrosis in children. Observation: Two male patients, aged 12 and 15, were hospitalized with acute mechanical bowel obstruction. There was an asymmetric, motionless meteorism and rectal emptiness. X-rays of the abdomen revealed an arch. Laparotomy found volvulus with necrosis of the sigmoid colon. The Hartmann-type colostomy and the ideal colectomy were the surgical procedures. Conclusion: Sigmoid volvulus is a rare abdominal emergency in children and severe in the necrosis stage.

scholarly journals Prediction of the Clinical Outcomes of Sigmoid Volvulus by Abdominal X-Ray: AXIS Classification System

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Rei Ishibashi ◽  
Ryota Niikura ◽  
Nobuya Obana ◽  
Sho Fukuda ◽  
Mayo Tsuboi ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Classification System ◽  
Sigmoid Volvulus ◽  
Trend Test ◽  
Coffee Bean ◽  
X Ray ◽  
Intestinal Necrosis ◽  
Group A ◽  
Group B ◽  
Therapeutic Decision Making

Aim. Early diagnosis and evaluation of the severity of sigmoid volvulus are necessary for management and early intervention. We developed a new predictive classification system for sigmoid volvulus based on X-ray findings. Methods. We retrospectively analyzed 66 patients diagnosed with sigmoid volvulus using the electronic medical records at the Osaki Citizen’s Hospital and the University of Tokyo Hospital from 2008–2015. We classified patients according to the coffee-bean sign mesenteric axis on X-ray (AXIS classification: group A, 0–90°; group B, 90–135°; and group C, >135°). We examined the association between AXIS classification and severe sigmoid volvulus, intestinal necrosis, need for surgery, 30-day mortality, and length of stay using the Cochran–Armitage trend test. Results. In total, 66 patients were analyzed. They had a mean age of 76.9 years, and 47 (71.0%) were male. They were classified into three groups according to the AXIS classification system (group A, 40 patients; group B, 23 patients; and group C, 3 patients). Group C had a significantly higher frequency of severe sigmoid volvulus (100%) compared to group B (30%) and group A (15%). AXIS classification was significantly associated with the severity of sigmoid volvulus (p=0.003), necrosis (p=0.004), and need for surgery (p=0.001), but not with the 30-day mortality or the length of stay. Conclusions. We developed the AXIS classification system to predict the severity of sigmoid volvulus. This new classification system may facilitate triage and therapeutic decision-making for sigmoid volvulus patients.

scholarly journals Sigmoid Volvulus with Widespread Bowel Ischemia after Endoscopic Reduction Successfully Treated with Elective Laparoscopic Surgery

2020 ◽  
Vol 14 (2) ◽  
pp. 286-290
Author(s):  
Koji Yasuda ◽  
Shoji Oura ◽  
Nozomi Kashu ◽  
Hiroyuki Yoshitake ◽  
Tomoya Takami ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Laboratory Test ◽  
Sigmoid Colon ◽  
Plain Radiograph ◽  
Sigmoid Volvulus ◽  
Colon Resection ◽  
Colon Perforation ◽  
Coffee Bean ◽  
Enhanced Computed Tomography ◽  
Successful Reduction

An 87-year-old man complaining of abdominal distention was referred to our hospital. Plain radiograph and enhanced computed tomography (CT) showed a dilated sigmoid colon with a coffee bean sign, leading to the diagnosis of sigmoid volvulus. Based on symptoms and the CT and laboratory test findings, we initially treated the patient with endoscopic reduction, resulting in successful reduction of the sigmoid volvulus with widespread presumed mucosal ischemia. Due both to the lack of emerging symptoms suggesting colon perforation and to the laboratory test findings after endoscopic reduction, we treated the patient without further urgent surgical intervention. Two months later, the patient underwent successful elective laparoscopic surgery with a redundant sigmoid colon resection and a functional end-to-end anastomosis. He has been well without any events for 20 months. Conservative treatment with careful observation should be taken into consideration in the treatment of sigmoid volvulus with mild to moderate ischemia after endoscopic reduction.

The Twisted Colon: A Review of Sigmoid Volvulus

2020 ◽  
Vol 23 (2) ◽  
pp. 90-94
Author(s):  
ABM Khurshid Alam ◽  
Masfique Ahmed Bhuiyan ◽  
Hasnat Zaman Zim ◽  
Tapas Kumar Das
Keyword(s):  
Sigmoid Colon ◽  
Emergency Surgery ◽  
Primary Anastomosis ◽  
Flexible Endoscopy ◽  
Sigmoid Resection ◽  
Primary Treatment ◽  
Sigmoid Volvulus ◽  
Laboratory Findings ◽  
Operative Findings ◽  
Resection And Anastomosis

In sigmoid volvulus (SV), the sigmoid colon wraps around itself and its mesentery. Sigmoid volvulus accounts for 2% to 50% of all colonic obstructions and has an interesting geographic dispersion. SV generally affects adults, and it is more common in males. The etiology of sigmoid volvulus is multifactorial and controversial; the main symptoms are abdominal pain, distention, and constipation, while the main signs are abdominal distention and tenderness. Routine laboratory findings are not pathognomonic: Plain abdominal X-ray radiographs show a dilated sigmoid colon and multiple small or large intestinal air-fluid levels, and abdominal CT and MRI demonstrate a whirled sigmoid mesentery. Flexible endoscopy shows a spiral sphincter-like twist of the mucosa. The diagnosis of sigmoid volvulus is established by clinical, radiological, endoscopic, and sometimes operative findings. Although flexible endoscopic detorsion is advocated as the primary treatment choice, emergency surgery is required for patients who present with peritonitis, bowel gangrene, or perforation or for patients whose non-operative treatment is unsuccessful. Although emergency surgery includes various non-definative or definitive procedures, resection with primary anastomosis is the most commonly recommended procedure. After a successful nonoperative detorsion, elective sigmoid resection and anastomosis is recommended. The overall mortality is 10% to 50%, while the overall morbidity is 6% to 24%. Journal of Surgical Sciences (2019) Vol. 23(2): 90-94

scholarly journals A rare case report of ovarian torsion with sigmoid volvulus

2020 ◽  
Vol 9 (7) ◽  
pp. 3055
Author(s):  
Shraddha A. Mevada ◽  
Archana A. Bhosale ◽  
Madhuri A. Mehendale
Keyword(s):  
Sigmoid Colon ◽  
Alimentary Tract ◽  
Abdominal Distension ◽  
Sigmoid Volvulus ◽  
Ovarian Torsion ◽  
Coffee Bean ◽  
Suspensory Ligament ◽  
Rare Case Report ◽  
Fluid Levels ◽  
Ovarian Pedicle

Ovarian torsion results from twisting of the ovary about the suspensory ligament, which contains the ovarian artery and vein, lymphatic’s, and nerves. Volvulus is a torsion of a segment of the alimentary tract, that often leads to intestinal obstruction. Ovarian torsion leading to sigmoid volvulus is the rarest complication which authors found in this case. Hence the case was presented. A 28-year-old women presented with acute pain in abdomen since 14 hours, followed by 2 episodes of vomiting, abdominal distension since 10 hours. Plain X-ray Abdomen erect was done which showed ‘Coffee bean’ sign with multiple air fluid levels suggestive of sigmoid volvulus. On laparotomy, after opening the peritoneum, large right ovarian cyst around 12×11×10 cm with solid and haemorrhagic content with long pedicle around 8 cm with 3 turns of torsion was noted. Abutting the ovarian mass, sigmoid colon was seen twisted around its mesentery including the twisted ovarian pedicle. Hence, the twisted component included the twisted ovarian pedicle and twisted sigmoid mesentery. Stepwise detorsion of ovarian pedicle followed by oophorectomy was done. For sigmoid volvulus, resection of vascular compromised sigmoid colon and descending colon stoma was done. Reanastomosis was done later after 3 months post operatively.

The role of the anatomy of the sigmoid colon in developing sigmoid volvulus: a cross-sectional study

2012 ◽  
Vol 35 (3) ◽  
pp. 249-257 ◽  
Author(s):  
Olusegun Isaac Alatise ◽  
Olusegun Ojo ◽  
Polycarp Nwoha ◽  
Ganiyat Omoniyi-Esan ◽  
Abidemi Omonisi
Keyword(s):  
Sigmoid Colon ◽  
Cross Sectional Study ◽  
Sigmoid Volvulus ◽  
Sectional Study ◽  
Cross Sectional

The Coffee Bean Sign: Diagnosing Sigmoid Volvulus in an 8-Year-Old Child

2015 ◽  
Vol 227 (02) ◽  
pp. 98-99 ◽  
Author(s):  
T. Theilen ◽  
H. Fiegel ◽  
S. Gfrörer ◽  
U. Rolle
Keyword(s):  
Sigmoid Volvulus ◽  
Coffee Bean

scholarly journals Sub-Acute Intestinal Obstruction – A Rare Complication in a patient with Autosomal Dominant Polycystic Kidney Disease

2021 ◽  
Vol 4 (03) ◽  
Author(s):  
Nazish Naseer ◽  
Sonia Yaqub
Keyword(s):  
Intestinal Obstruction ◽  
Rare Complication ◽  
Acute Intestinal Obstruction ◽  
Polycystic Kidney ◽  
Radiological Findings ◽  
X Ray ◽  
Distended Abdomen ◽  
X Ray Computed ◽  
Autosomal Dominant Polycystic Kidney ◽  
Tomography Scan

associated with vomiting and constipation. On examination he was an obese, ill looking male with a distended abdomen and bilateral palpable flank masses. Gut sounds were sluggish. Small and large bowel loops were found to be dilated on abdominal x-ray. Computed tomography scan of the abdomen showed grossly enlarged kidneys occupying almost whole of the abdomen pushing small bowel loops anteriorly. Based on clinical and radiological findings a diagnosis of sub-acute intestinal obstruction was made. Patient was managed conservatively (i.e. with NG tube and rectal decompression). This case highlights intestinal obstruction as a rare complication of ADPKD.

scholarly journals An unusual presentation of foreign body rectum

2021 ◽  
Author(s):  
Samir Paruthy ◽  
Shivani B. Paruthy
Keyword(s):  
Foreign Body ◽  
Sigmoid Colon ◽  
Multidisciplinary Management ◽  
Associated Injuries ◽  
Lower Abdomen ◽  
Anal Region ◽  
X Ray ◽  
Patient Reported ◽  
Abdominal Examination ◽  
Successful Retrieval

Retrieval of rectal foreign body (FB) is a surgical dilemma. Variables including FB size, shape, make, time of insertion, presentation in ER, associated injuries, local edema, contamination, reluctance to seek medical aid, multiple unsuccessful attempts for self-retrieval masked by improper history and concealing the actual facts makes surgical management challenging. In this study, two unusual cases of FB in rectum and retrievals were presented. Case 1 was a 22 year old boy with a metallic glass tumbler in rectum reported after 12 days with constipation and pelvic pain. Repeated self-attempts for removal by the patient further pushed the FB upwards. Retrieval of rectal FB was done from rectum with repair and diversion colostomy which was closed later. Patient confessed this was his thirteenth attempt with the same object with successful retrieval all the time in last nine months. Case 2 was a 27 year old boy who inserted a sharp iron rod (used for picking ice) in the anal region which migrated to sigmoid colon without perforation of the viscera. Patient reported after three days with sharp shooting pain in left lower abdomen which aggravated on defecation. Abdominal examination revealed no sign of peritonitis, X-ray and CECT abdomen unexpectedly revealed no viscera perforation. Retrieval of FB stuck at sigmoid colon was undertaken with repair and diversion colostomy and closed later. From the study it was concluded that the retrieval of FB with proper psychological evaluation along with rehabilitation of the patient in society was a multidisciplinary management. Actual algorithm of management of these cases was beyond the surgical clinics and one-time emergency FB retrievals.

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