Time for some Radiology 😉
The coffee bean sign / the bent inner tube sign Volvulus is a specific cause of obstruction with characteristic X-ray appearances Twisting of the bowel or 'volvulus' - is a specific cause of bowel obstruction which can have characteristic appearances on an abdominal X-ray. The most common location of volvulus is the sigmoid colon (∼60%), followed by ‘cecal’ volvulus (20–40%) Causes - There can be many different causes, a few being., *an enlarged colon *abdominal adhesions that develop after surgery, injury, or infection *diseases of the large intestine, such as Hirschsprung's disease *a colon that is not attached to the abdominal wall *a narrow connection at the base of the colon *chronic constipation *pregnancy Symptoms and signs - Abdominal pain, abdominal bloating, vomiting, constipation, bloody stool. The radiological part - SIGMOID VOLVULUS - 'COFFEE BEAN ' SIGN The sigmoid colon is very dilated because it is twisted at the root of its mesentery in the left iliac fossa (LIF). The proximal large bowel is also dilated. The twisted loop of sigmoid colon is said to resemble a coffee bean. As in this case the loop of dilated sigmoid colon or 'coffee bean' - usually points upwards towards the diaphragm. This patient is at high risk of perforation and/or bowel ischaemia. If untreated this can lead either to perforation, due to excessive dilatation or to ischaemia due to compromise of the blood supply. Treatment strategy - Elective laparoscopic sigmoid resection and right hemicolectomy after endoscopic decompression is increasingly being described and performed to treat patients with volvulus.
