A 92 yo female presents with one week of progressive abdominal pain, distention and nausea.  She cannot remember when she had her last bowel movement.  Her vital signs are within normal limits but she appears uncomfortable.  Abdomen is distended but not peritoneal.  A CT scan is shown.  What's the diagnosis?  Scroll down for answer.

Answer:  Sigmoid volvulus

• Greater incidence in men, mean age 70, more common in countries outside US (only 10% of obstructions in US, >50% in other countries)
• Presentation
• progressive abdominal pain, nausea, distention, constipation
• nausea several days after onset of pain
• Differential
• SBO of other etioloty
• pseudo obstruction (Ogilvie's syndrome - loss of synpathetic innervation of colon; usually in severely ill with comorbidites)
• toxic megacolon
• Diagnosis
• Clinical + CT
• can start with plain xray - diagnositc ~60% time
• Basic labs including lactate
• Management
• Emergent surgery consult for probable detorsion /decompression +/-surgical resection

References:

Hoden, RA. Sigmoid volvulus. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on December 8, 2021.)

Tintinalli, JE. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York, NY: McGraw-Hill Education LLC, 2016