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Sigmoid volvulus in a young woman nearly misdiagnosed as fecal impaction.
J Emerg Med 2013; 44(3):611-3JE

Abstract

BACKGROUND

Volvulus of the sigmoid colon is a potentially life-threatening condition rarely seen in younger age groups and is male predominant.

OBJECTIVE

We report a previously healthy young woman with the triad of constipation, progressive abdominal distension, and severe abdominal pain, with plain-film x-ray studies mimicking stool impaction and computed tomography disclosing the typical findings of sigmoid volvulus. The case reminds Emergency Physicians to consider sigmoid volvulus if mechanical obstruction is suspected, even in a young patient.

CASE REPORT

A 33-year-old woman had the triad of symptoms for 3 days. Physical examination did not show peritoneal signs. Digital rectal examination disclosed neither palpable mass nor stool in rectum. Computed tomography revealed "coffee bean" sign and "whirl" sign. Laparoscopy demonstrated redundant sigmoid colon and she was treated with detorsion with colopexy uneventfully.

CONCLUSIONS

Sigmoid volvulus is rarely seen in developed countries. Clinical manifestations vary with disease progression, but it typically presents with a triad of constipation, progressive abdominal distension, and severe abdominal pain. Plain-film x-ray studies can demonstrate a coffee bean or "omega loop" (inverted-U sigmoid) sign in <60% cases, but it was reported as high as 86% in computed tomography. The whirl sign on computed tomography might also be observed. The cause is multifactorial and colonic length is the most important predisposing factor. Flexible colon fiberscopic decompression followed by elective definitive surgery is the treatment choice, but exploratory laparotomy is mandatory if any complicated entity occurs. The mortality rate is still >50% when bowel gangrene develops.

Authors+Show Affiliations

Department of Emergency Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

23079147

Citation

Chang, Chih-Jung, et al. "Sigmoid Volvulus in a Young Woman Nearly Misdiagnosed as Fecal Impaction." The Journal of Emergency Medicine, vol. 44, no. 3, 2013, pp. 611-3.
Chang CJ, Hsieh TH, Tsai KC, et al. Sigmoid volvulus in a young woman nearly misdiagnosed as fecal impaction. J Emerg Med. 2013;44(3):611-3.
Chang, C. J., Hsieh, T. H., Tsai, K. C., & Fan, C. M. (2013). Sigmoid volvulus in a young woman nearly misdiagnosed as fecal impaction. The Journal of Emergency Medicine, 44(3), pp. 611-3. doi:10.1016/j.jemermed.2012.02.084.
Chang CJ, et al. Sigmoid Volvulus in a Young Woman Nearly Misdiagnosed as Fecal Impaction. J Emerg Med. 2013;44(3):611-3. PubMed PMID: 23079147.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sigmoid volvulus in a young woman nearly misdiagnosed as fecal impaction. AU - Chang,Chih-Jung, AU - Hsieh,Tsung-Hung, AU - Tsai,Kuang-Chau, AU - Fan,Chieh-Min, Y1 - 2012/10/15/ PY - 2011/04/16/received PY - 2011/09/12/revised PY - 2012/02/19/accepted PY - 2012/10/20/entrez PY - 2012/10/20/pubmed PY - 2013/8/30/medline SP - 611 EP - 3 JF - The Journal of emergency medicine JO - J Emerg Med VL - 44 IS - 3 N2 - BACKGROUND: Volvulus of the sigmoid colon is a potentially life-threatening condition rarely seen in younger age groups and is male predominant. OBJECTIVE: We report a previously healthy young woman with the triad of constipation, progressive abdominal distension, and severe abdominal pain, with plain-film x-ray studies mimicking stool impaction and computed tomography disclosing the typical findings of sigmoid volvulus. The case reminds Emergency Physicians to consider sigmoid volvulus if mechanical obstruction is suspected, even in a young patient. CASE REPORT: A 33-year-old woman had the triad of symptoms for 3 days. Physical examination did not show peritoneal signs. Digital rectal examination disclosed neither palpable mass nor stool in rectum. Computed tomography revealed "coffee bean" sign and "whirl" sign. Laparoscopy demonstrated redundant sigmoid colon and she was treated with detorsion with colopexy uneventfully. CONCLUSIONS: Sigmoid volvulus is rarely seen in developed countries. Clinical manifestations vary with disease progression, but it typically presents with a triad of constipation, progressive abdominal distension, and severe abdominal pain. Plain-film x-ray studies can demonstrate a coffee bean or "omega loop" (inverted-U sigmoid) sign in <60% cases, but it was reported as high as 86% in computed tomography. The whirl sign on computed tomography might also be observed. The cause is multifactorial and colonic length is the most important predisposing factor. Flexible colon fiberscopic decompression followed by elective definitive surgery is the treatment choice, but exploratory laparotomy is mandatory if any complicated entity occurs. The mortality rate is still >50% when bowel gangrene develops. SN - 0736-4679 UR - https://www.unboundmedicine.com/medline/citation/23079147/Sigmoid_volvulus_in_a_young_woman_nearly_misdiagnosed_as_fecal_impaction_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0736-4679(12)01077-3 DB - PRIME DP - Unbound Medicine ER -