Clinical Questions -2


Presentation


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.


Laboratory studies


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


CT Scan Image



What is your diagnosis?


A. Intussusception

B. Sigmoid volvulus

C. Ovarian tumor

D. Bladder tumor



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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