Clinical Questions -2

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Presentation

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A 71-year-old woman presented to emergency department with a 4-day history of abdominal pain and vomiting. The physical exam revealed hypotension and a distended abdomen with generalized tenderness.

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Laboratory studies

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Laboratory studies revealed hyperkalemia and elevated creatinine, lactate, and troponin. Given her hemodynamic instability, an emergent noncontrast abdominal computed tomography (CT) was obtained

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CT Scan Image

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What is your diagnosis?

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A. Intussusception

B. Sigmoid volvulus

C. Ovarian tumor

D. Bladder tumor

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The coronal image demonstrated a twisted loop of sigmoid with two air-filled compartments and a central double wall ending at the point of the twist, referred to as the “coffee bean” sign. This has also been observed in abdominal X-rays and is highly suggestive of sigmoid volvulus

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