 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 sev...
•Coffee Bean Sign:     •As closed loop of bowel distends     with gas, walls dilate, causing     coffee bean like appearan...
 Left Flank Overlap Sign:   Dilated Sigmoid Colon    overlaps Descending    Colon   Can see descending colon    behind ...
 IV & IV Fluids Analgesics & Antiemetics NG tube decompression Surgical Consult Reduction with endoscopy can by 85-95...
 Commonly seen in elderly patients with history of  chronic constipation, often neurologically debilitated. Complication...
 Feldman, Deborah. “The Coffee Bean Sign” Radiology    http://radiology.rsna.org/content/216/1/178.full   www.diagnostic...
Sigmoid volvulus (2)
Sigmoid volvulus (2)
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Sigmoid volvulus (2)

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Sigmoid volvulus (2)

  1. 1.  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.
  2. 2. •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
  3. 3.  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.
  4. 4.  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
  5. 5.  Commonly seen in elderly patients with history of chronic constipation, often neurologically debilitated. Complications: Colonic Ischemia, Perforation, Peritonitis, Sepsis
  6. 6.  Feldman, Deborah. “The Coffee Bean Sign” Radiology http://radiology.rsna.org/content/216/1/178.full www.diagnosticimaging.com/display/article/113619/141 0628 http://www.learningradiology.com/notes/ginotes/sig moidvolvpage.htm Schwartz, David. Emergency Radiology. 2000. pg 527- 529. Tintanelli’s Emergency Medicine: A Comprehensive Study Guide. Chapter 79 Intestinal Obstruction

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