eMedicine Specialties > Radiology > Gastrointestinal

Sigmoid Volvulus: Multimedia

Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, Consultant Radiologist and Honorary Professor, North Manchester General Hospital Pennine Acute NHS Trust, UK
Coauthor(s): Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute; John MT Howat, MB, BCh, MD, FRCS, Consultant General and Colorectal Surgeon, North Manchester General Hospital, UK
Contributor Information and Disclosures

Updated: Aug 20, 2009

Multimedia

This radiograph demonstrates a greatly dilated si...
(Enlarge Image)
Media file 1: This radiograph demonstrates a greatly dilated sigmoid that almost fills the entire abdomen (same patient in Images 1-3). Note the coffee bean sign. The remainder of the large bowel is not dilated, presumably because the proximal point of the twist is not causing obstruction and thus allows drainage into the sigmoid.
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This radiograph demonstrates a greatly dilated si...

This radiograph demonstrates a greatly dilated sigmoid that almost fills the entire abdomen (same patient in Images 1-3). Note the coffee bean sign. The remainder of the large bowel is not dilated, presumably because the proximal point of the twist is not causing obstruction and thus allows drainage into the sigmoid.

Erect abdominal radiograph (same patient in Image...
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Media file 2: Erect abdominal radiograph (same patient in Images 1-3). This image shows fluid levels in the distended sigmoid loop.
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Erect abdominal radiograph (same patient in Image...

Erect abdominal radiograph (same patient in Images 1-3). This image shows fluid levels in the distended sigmoid loop.

This radiograph shows decompression of the sigmoi...
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Media file 3: This radiograph shows decompression of the sigmoid loop following retrograde passage of a flatus tube (same patient in Images 1-3).
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This radiograph shows decompression of the sigmoi...

This radiograph shows decompression of the sigmoid loop following retrograde passage of a flatus tube (same patient in Images 1-3).

Supine abdominal radiograph in a 6-year-old child...
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Media file 4: Supine abdominal radiograph in a 6-year-old child from an area in which roundworms are endemic. This image shows a sigmoid volvulus. The sigmoid loop is dilated and associated with mild proximal large-bowel dilatation.
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Supine abdominal radiograph in a 6-year-old child...

Supine abdominal radiograph in a 6-year-old child from an area in which roundworms are endemic. This image shows a sigmoid volvulus. The sigmoid loop is dilated and associated with mild proximal large-bowel dilatation.

This erect radiograph shows fluid levels in the s...
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Media file 5: This erect radiograph shows fluid levels in the sigmoid loop and in the transverse colon (same patient as in Image 4).
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This erect radiograph shows fluid levels in the s...

This erect radiograph shows fluid levels in the sigmoid loop and in the transverse colon (same patient as in Image 4).

Erect abdominal radiograph demonstrating a giant ...
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Media file 6: Erect abdominal radiograph demonstrating a giant sigmoid diverticulum. This image shows a dilated loop of bowel with air-fluid levels and intraluminal feces. This appearance mimics that of an enlarged cecum or sigmoid loop.
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Erect abdominal radiograph demonstrating a giant ...

Erect abdominal radiograph demonstrating a giant sigmoid diverticulum. This image shows a dilated loop of bowel with air-fluid levels and intraluminal feces. This appearance mimics that of an enlarged cecum or sigmoid loop.

Radiograph from an enema examination with water-s...
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Media file 7: Radiograph from an enema examination with water-soluble contrast material in an unprepared bowel (same patient as in Image 6). This image shows a giant sigmoid diverticulum that contains feces.
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Radiograph from an enema examination with water-s...

Radiograph from an enema examination with water-soluble contrast material in an unprepared bowel (same patient as in Image 6). This image shows a giant sigmoid diverticulum that contains feces.

More on Sigmoid Volvulus

Overview: Sigmoid Volvulus
Imaging: Sigmoid Volvulus
Follow-up: Sigmoid Volvulus
Multimedia: Sigmoid Volvulus
References
Further Reading
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References

  1. Atamanalp SS, Yildirgan MI, Basoglu M, et al. Clinical presentation and diagnosis of sigmoid volvulus: outcomes of 40-year and 859-patient experience. J Gastroenterol Hepatol. May 24 2007;epub ahead of print. [Medline].

  2. Kedir M, Kotisso B, Messele G. Ileosigmoid knotting in Gondar teaching hospital north-west Ethiopia. Ethiop Med J. Oct 1998;36(4):255-60. [Medline].

  3. Raveenthiran V. The ileosigmoid knot: new observations and changing trends. Dis Colon Rectum. Aug 2001;44(8):1196-200. [Medline].

  4. Peitz HG. [Volvulus in childhood] [German]. Radiologe. Jun 1997;37(6):439-45. [Medline].

  5. Puthu D, Rajan N, Shenoy GM, Pai SU. The ileosigmoid knot. Dis Colon Rectum. Feb 1991;34(2):161-6. [Medline].

  6. Young WS, White A, Grave GF. The radiology of ileosigmoid knot. Clin Radiol. Mar 1978;29(2):211-6. [Medline].

  7. Larkin JO, Thekiso TB, Waldron R, Barry K, Eustace PW. Recurrent sigmoid volvulus - early resection may obviate later emergency surgery and reduce morbidity and mortality. Ann R Coll Surg Engl. Apr 2009;91(3):205-9. [Medline].

  8. Jumbi G, Kuremu RT. Emergency resection of sigmoid volvulus. East Afr Med J. Aug 2008;85(8):398-405. [Medline].

  9. Anand AC, Sashindran VK, Mohan L. Gastrointestinal problems at high altitude. Trop Gastroenterol. Oct-Dec 2006;27(4):147-53. [Medline].

  10. Lee SH, Park YH, Won YS. The ileosigmoid knot: CT findings. AJR Am J Roentgenol. Mar 2000;174(3):685-7. [Medline]. [Full Text].

  11. Feldman D. The coffee bean sign. Radiology. Jul 2000;216(1):178-9. [Medline]. [Full Text].

  12. Javors BR, Baker SR, Miller JA. The northern exposure sign: a newly described finding in sigmoid volvulus. AJR Am J Roentgenol. Sep 1999;173(3):571-4. [Medline]. [Full Text].

  13. Hirao K, Kikawada M, Hanyu H, Iwamoto T. Sigmoid volvulus showing "a whirl sign" on CT. Intern Med. 2006;45(5):331-2. [Medline]. [Full Text].

  14. Shaff MI, Himmelfarb E, Sacks GA, Burks DD, Kulkarni MV. The whirl sign: a CT finding in volvulus of the large bowel. J Comput Assist Tomogr. Mar-Apr 1985;9(2):410. [Medline].

  15. Ogata M, Imai S, Hosotani R, et al. Abdominal sonography for the diagnosis of large bowel obstruction. Surg Today. 1994;24(9):791-4. [Medline].

  16. Lim JH, Ko YT, Lee DH, Lee HW, Lim JW. Determining the site and causes of colonic obstruction with sonography. AJR Am J Roentgenol. Nov 1994;163(5):1113-7. [Medline]. [Full Text].

  17. Safioleas M, Chatziconstantinou C, Felekouras E, Stamatakos M, Papaconstantinou I, Smirnis A, et al. Clinical considerations and therapeutic strategy for sigmoid volvulus in the elderly: a study of 33 cases. World J Gastroenterol. Feb 14 2007;13(6):921-4. [Medline].

  18. Oren D, Atamanalp SS, Aydinli B, Yildirgan MI, Basoglu M, Polat KY, et al. An algorithm for the management of sigmoid colon volvulus and the safety of primary resection: experience with 827 cases. Dis Colon Rectum. Apr 2007;50(4):489-97. [Medline].

  19. Barloon TJ, Lu CC. Diagnostic imaging in the evaluation of constipation in adults. Am Fam Physician. Aug 1997;56(2):513-20. [Medline].

  20. Bhartia B, Cronin P, Spencer JA. Case of the month. A twist in the tail. Br J Radiol. Sep 2000;73(873):1025-6. [Medline]. [Full Text].

  21. Bula G, Niemiec A, Podwinska E. [Low obturation ileus caused by gallstone incarceration in sigmoid colon] [Polish]. Wiad Lek. 1999;52(7-8):413-6. [Medline].

  22. Carden AB. Acute volvulus of the sigmoid colon. Aust N Z J Surg. May 1966;35(4):307-12. [Medline].

  23. Maalouf EF, Fagbemi A, Duggan PJ, et al. Magnetic resonance imaging of intestinal necrosis in preterm infants. Pediatrics. Mar 2000;105(3 pt 1):510-4. [Medline]. [Full Text].

  24. Naing T, Ray S, Loughran CF. Giant sigmoid diverticulum: a report of three cases. Clin Radiol. Mar 1999;54(3):179-81. [Medline].

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Further Reading

Related eMedicine topics

Obstruction, Large Bowel [Emergency Medicine]
 
Colonic Obstruction [Gastroenterology]

Megacolon, Toxic [Gastroenterology]

Megacolon, Chronic [Gastroenterology]
 
Toxic Megacolon [Radiology]

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Keywords

sigmoid volvulus, intestinal torsion, gastrointestinal tract, sigmoid colon, large bowel, chronic constipation, roundworm, large bowel obstruction, large-bowel obstruction, pneumoperitoneum

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Contributor Information and Disclosures

Author

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, Consultant Radiologist and Honorary Professor, North Manchester General Hospital Pennine Acute NHS Trust, UK
Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR is a member of the following medical societies: American Association for the Advancement of Science, American Institute of Ultrasound in Medicine, British Medical Association, British Society of Interventional Radiology, Royal College of Physicians, Royal College of Physicians and Surgeons of the United States, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Coauthor(s)

Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Sumaira MacDonald, MBChB, PhD, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

John MT Howat, MB, BCh, MD, FRCS, Consultant General and Colorectal Surgeon, North Manchester General Hospital, UK
John MT Howat, MB, BCh, MD, FRCS is a member of the following medical societies: Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Medical Editor

Eric P Weinberg, MD, Associate Professor, Department of Radiology, University of Rochester Medical Center, Strong Memorial Hospital
Eric P Weinberg, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Spencer B Gay, MD, Professor of Radiology, Director of Body Computed Tomography, Department of Radiology, University of Virginia Health Sciences Center
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

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