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Case of the Week 338

What's the most likely diagnosis?

  • 58 year-old male with abdominal pain and constipation

  1. Pneumoperitoneum
  2. Emphysematous cystitis
  3. Diverticulitis
  4. Gastric dilatation
  5. Sigmoid volvulus

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5. Sigmoid volvulus

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Sigmoid Volvulus

General Considerations

  • Twisting of loop of intestine around its mesenteric attachment site may occur at various sites in the GI tract
    • Most commonly: sigmoid & cecum
    • Rarely: stomach, small intestine, transverse colon
    • Results in partial or complete obstruction
    • May also compromise bowel circulation resulting in ischemia
  • Sigmoid volvulus most common form of GI tract volvulus
    • Accounts for up to 8% of all intestinal obstructions
  • Most common in elderly persons (often neurologically impaired)
  • Patients almost always have a history of chronic constipation


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This Week

58 year-old man with abdominal pain and constipation

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