Sigmoid volvulus

Case contribution: Dr Radhiana Hassan


  • A 67 years old man
  • Had underlying bronchial asthma
  • History of appendicectomy at 11 years old
  • Presented with abdominal pain for 3 days, generalised and colicky in nature. Pain score 4-5.
  • Associated with abdominal distension, NBO and not passing flatus. NO PR bleed.
  • Had history of loss of appetite and loss of weight for 1 month
  • Father had liver cancer, no other malignancy in family
  • Clinical examination shows distended abdomen, generalized voluntary guarding, tingling bowel sound, no mass palpable. No abnormal lymph node.
  • Rectal examination shows hypertrophic anal papillae, empty rectum, enlarged prostate with no other mass lesion.
Chest radiograph do not demonstrate free air under the diaphragm.
Abdominal radiograph in supine view

Abdominal radiograph findings:

  • Dilated bowel loops, no haustration
  • It demonstrate coffee-bean sign
  • No free intraperitoneal air is seen
  • Abundance fecal material in colon

Intraoperative findings:

  • Gangrenous dilated sigmoid colon
  • No perforation, no fecal contamination
  • Hemorrhagic fluid upon entering the peritoneum
  • Dilated descending and transverse colon
  • Normal caecum, small bowel, stomach, gallbladder and liver
  • EBL= 100 ml.
  • Sigmoid colectomy and hartmann procedure performed

Diagnosis: Sigmoid volvulus


  • Sigmoid volvulus is the most common GI tract volvulus
  • It accounts for about 8% of all intestinal obstructions
  • Patient almost always have history of constipation.
  • It has a high mortality rate of 20-25%
  • Peak age >50 years old
  • Abdominal plain film is usually diagnostic. It shows inverted U-shaped distended sigmoid loop, loss of haustra
  • A coffee-bean sign is a well-known sign showing a midline crease corresponding to mesenteric root in a greatly distended sigmoid
  • The distended loop points towards the right upper quadrant as compared to caecal volvulus which usually pointing to left upper quadrant
Author: radhianahassan