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A Symptomatic Coffee Bean: Acute Sigmoid Volvulus.
Case Rep Gastroenterol 2017 May-Aug; 11(2):348-351CR

Abstract

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.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

28626382

Citation

Scharl, Michael, and Luc Biedermann. "A Symptomatic Coffee Bean: Acute Sigmoid Volvulus." Case Reports in Gastroenterology, vol. 11, no. 2, 2017, pp. 348-351.
Scharl M, Biedermann L. A Symptomatic Coffee Bean: Acute Sigmoid Volvulus. Case Rep Gastroenterol. 2017;11(2):348-351.
Scharl, M., & Biedermann, L. (2017). A Symptomatic Coffee Bean: Acute Sigmoid Volvulus. Case Reports in Gastroenterology, 11(2), pp. 348-351. doi:10.1159/000475918.
Scharl M, Biedermann L. A Symptomatic Coffee Bean: Acute Sigmoid Volvulus. Case Rep Gastroenterol. 2017;11(2):348-351. PubMed PMID: 28626382.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Symptomatic Coffee Bean: Acute Sigmoid Volvulus. AU - Scharl,Michael, AU - Biedermann,Luc, Y1 - 2017/05/22/ PY - 2017/02/01/received PY - 2017/04/18/accepted PY - 2017/6/20/entrez PY - 2017/6/20/pubmed PY - 2017/6/20/medline KW - Acute sigmoid volvulus KW - Colonoscopy KW - Sigmoid colon SP - 348 EP - 351 JF - Case reports in gastroenterology JO - Case Rep Gastroenterol VL - 11 IS - 2 N2 - 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. SN - 1662-0631 UR - https://www.unboundmedicine.com/medline/citation/28626382/A_Symptomatic_Coffee_Bean:_Acute_Sigmoid_Volvulus_ L2 - https://www.karger.com?DOI=10.1159/000475918 DB - PRIME DP - Unbound Medicine ER -