Coffee Bean Sign in Cecal Volvulus
An 87-year-old man with chronic kidney disease, hypertension, and atrial fibrillation presented to the emergency department on a remote South Atlantic island where he resided with a 3-day history of constipation and lower abdominal pain. The patient’s body temperature was 39.2°C, the heart rate was 97 beats per minute, the respiratory rate was 28 breaths per minute, and the blood pressure was normal. Physical examination was notable for abdominal distention and tenderness to palpation of the right lower quadrant without rebound or guarding. A plain radiograph of the abdomen showed an air-filled loop of large bowel resembling a coffee bean (Panel A, arrows; supine view), a finding that may be seen in cecal or sigmoid volvulus. Although computed tomography of the abdomen is the definitive study in the diagnosis of bowel volvulus, it was not available at this hospital. On the basis of the available clinical data, the patient was taken urgently to the operating room. A cecal volvulus without signs of bowel compromise was identified (Panel B, arrow) and successfully detorsed. Owing to intraoperative hemodynamic instability, a cecopexy and cecostomy were performed rather than an ileocecectomy or right colectomy. The patient’s postoperative course was uncomplicated. At 6 months of follow-up, he was doing well and declined ostomy reversal at that time.