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A case of sigmoid volvulus
  1. Aikaterini Leventi1,
  2. Thomas Frederick James Clifford1,
  3. Amy Arnold2,
  4. Charles H Knowles2,
  5. Joanne E Martin2
  1. 1 Department of Colorectal Surgery, Barts Health NHS Trust, London, UK
  2. 2 Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  1. Correspondence to Ms Aikaterini Leventi, Department of Colorectal Surgery, The Royal London Hospital, Whitechapel, London, UK E1 1BZ; ksleventi{at}yahoo.com

Abstract

Clinical presentation A 53-year-old man was admitted with a 2-week history of bowel obstruction on a background of gradually worsening dyspeptic symptoms associated with vomiting and weight loss. He was under regular gastroenterology review for Barrett’s oesophagus and had a recent endoscopic diagnosis of megaduodenum (mainly D1 dilatation) confirmed by barium study (figure 1). He was also known to have bladder emptying problems and an enlarged bladder. His mother died at age 28 due to ‘megacolon’, and he has a monozygotic twin brother with Barrett’s oesophagus.

Figure 1

Barium meal and follow through confirmed dilation of the duodenum with normal small bowel transit.

Abdominal X-ray showed marked large bowel dilatation (figure 2) and urgent CT scan of the abdomen and pelvis confirmed sigmoid volvulus (figure 3).

Figure 2

Urgent abdominal X-ray with prominent large bowel dilatation.

Figure 3

Representative axial image from urgent CT scan  of the abdomen and pelvis indicating sigmoid volvulus.

Despite two attempts at endoscopic decompression, he eventually underwent Hartmann’s sigmoidectomy. His postoperative recovery was delayed by prolonged ileus requiring nasogastric drainage and parenteral nutritional support. He was discharged on the 19th day postoperatively.

Question Aside from the immediate volvulus presentation, should any other diagnosis be considered?

  • gastrointestinal muscle
  • gastrointestinal motility
  • intestinal motility
  • intestinal obstruction

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Footnotes

  • Contributors CHK and AL conceived the study. AL wrote the manuscript. TFJC and AA collected and edited the data. JEM analysed the data. CHK and JEM critically revised the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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