|Year : 2018 | Volume
| Issue : 2 | Page : 159-160
Coffee-bean sign: Classic sign of sigmoid volvulus
Mohd Ilyas, Gh Mohammad Wani, Arif Ahmad Wani, Jan Mohd Suhail, Kifayat Hussain Ganaie, Tariq Gojwari
Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
|Date of Web Publication||9-Apr-2018|
Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar - 190 011, Jammu and Kashmir
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ilyas M, Wani GM, Wani AA, Suhail JM, Ganaie KH, Gojwari T. Coffee-bean sign: Classic sign of sigmoid volvulus. CHRISMED J Health Res 2018;5:159-60
|How to cite this URL:|
Ilyas M, Wani GM, Wani AA, Suhail JM, Ganaie KH, Gojwari T. Coffee-bean sign: Classic sign of sigmoid volvulus. CHRISMED J Health Res [serial online] 2018 [cited 2019 Mar 21];5:159-60. Available from: http://www.cjhr.org/text.asp?2018/5/2/159/229586
| Presentation|| |
A 14-year-old male was admitted with the complaints of abdominal distension, constipation, abdominal bloating, and dull-aching abdominal pain for 2 days. There was no history of fever and vomiting. He had not eaten anything for the past 2 days. He had no neurological problems and was not on any medications. Family history was insignificant.
| Assessment|| |
On physical examination, the heart rate was 98 bpm, blood pressure 130/82 mmHg, and respiratory rate 18 breaths/min. The abdomen was distended with tenderness in the left iliac fossa region. There was no abdominal thrill. The patient was afebrile. The hemogram profile revealed hemoglobin 12 gm%. The complete blood count, renal function tests, and coagulation profile were normal.
An erect abdominal radiograph was ordered immediately which revealed a large dilated gut loop in occupying more than half of the abdomen with a classic coffee-bean appearance with absent rectal gas [Figure 1].
|Figure 1: Abdominal radiograph showing a large dilated bowel loop with coffee-bean appearance and dense bands converging to the right lower quadrant with absent rectal gas findings consistent with sigmoid volvulus|
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| Diagnosis|| |
The radiographic findings in combination with clinical examination findings were classic for sigmoid volvulus. It occurs due to twisting of the sigmoid colon over sigmoid mesocolon. The sigmoid volvulus is an emergency keeping in mind the consequence of bowel necrosis. The other signs on abdominal radiography are absent rectal gas and Frimann-Dahl's sign (dense lines converging toward site of obstruction).
Other diagnostic modalities used in the diagnosis of sigmoid volvulus are fluoroscopy and computed tomography, but these are time-consuming as they require oral contrast ingestion. These modalities are used when the diagnosis is uncertain on abdominal radiograph.
| Management|| |
Colonoscopic detorsion was performed in this patient. The postintervention period was uneventful. This was followed by laparoscopic sigmoidopexy at 2-week interval to prevent recurrent volvulus.
There are multiple treatment modalities available for the sigmoid volvulus. In the acute setting, rectal tube insertion or colonoscopic detorsion form the preferred modalities with a success rate of >90%. In the chronic setting where there is evidence of bowel necrosis or when the medical management is unsuccessful, the management option is sigmoidectomy with bowel anastomosis or colostomy.
The present case was managed conservatively in the emergency setting followed by a preventive laparoscopic sigmoidopexy.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Katsikogiannis N, Machairiotis N, Zarogoulidis P, Sarika E, Stylianaki A, Zisoglou M, et al.
Management of sigmoid volvulus avoiding sigmoid resection. Case Rep Gastroenterol 2012;6:293-9.
Lou Z, Yu ED, Zhang W, Meng RG, Hao LQ, Fu CG, et al.
Appropriate treatment of acute sigmoid volvulus in the emergency setting. World J Gastroenterol 2013;19:4979-83.