Sigmoid Volvulus

Twisted

Step 1: View clinicals

A 70 year old man presents with worsening pain in the left lower abdomen associated with an absence of bowel movements and passage of flatus for 6 days. He started vomiting just prior to admission. His surgical and medical histories are unremarkable.


Step 2: Order all relevant investigations

Serum Electrolytes

Na+ 135 mEq/l (135 - 145) K+ 4.2 mEq/l (3.5 - 5.5) Cl- 101 mEq/l (95 - 105)

Full Blood Count

WBC/DC: 9,000/mm3 (4,600 - 11,000) Hb: 14 g/dl (13.8 - 18 g/dl) Platelets: 320,000/mm3 (150,000 - 450,000)

Upright X-Ray Abdomen

The X-Ray shows multiple air-fluid levels and dilated loops of large bowel. There is a markedly distended loop of sigmoid colon assuming an inverted U-shape.

CT Abdomen & Pelvis

The CT scan shows multiple dilated loops of colon with air-fluid levels and a central 'whirl' sign.


Step 3: Select appropriate management

Nasogastric tube
Start IV Fluids
Start IV Antibiotics
Endoscopic decompression


Score: ★★☆