80 y/o white male T: 99.0 P 100 R 16 BP 120/80 presents c/o acute onset Gen: appears to be in pain, of severe abdominal HEENT: PERRL, NCAT, pain, abdominal oropharnyx clear distention, and CV: RRR, no, m/r/g constipation. He notes Pulm: CTAB that he has had Abd: TTP diffusely worse in occasional episodes of LLQ; distended abdomen Left severe pain in LLQ similar side > Right side; tympanic to this but have resolved abdomen to percussion Ext: 2+ pulse, no c/c/e on there own. Patient has a history of chronic constipation.
•Coffee Bean Sign: •As closed loop of bowel distends with gas, walls dilate, causing coffee bean like appearance.•Lose Haustral Markings•Cleft •Arises from Left Pelvis and points towards RUQ (usually)•Additional Findings in SigmoidVolvulus (Not seen Here) •Left Flank Overlap Sign •Northern Exposure Sign
Left Flank Overlap Sign: Dilated Sigmoid Colon overlaps Descending Colon Can see descending colon behind dilated bowel. Northern Exposure Sign: Dilated Sigmoid Colon reaches superiorly to Transverse Colon.
IV & IV Fluids Analgesics & Antiemetics NG tube decompression Surgical Consult Reduction with endoscopy can by 85-95% successful but has a 60% recurrence rate. Sigmoid Resection is definitive treatment
Commonly seen in elderly patients with history of chronic constipation, often neurologically debilitated. Complications: Colonic Ischemia, Perforation, Peritonitis, Sepsis