An 80-year-old man presented with acute severe abdominal pain, distention, and constipation. Physical exam revealed a distended abdomen with tenderness worse in the lower left quadrant. Imaging showed signs of sigmoid volvulus including the coffee bean sign and left flank overlap sign. Treatment included decompression, IV fluids, analgesics, and surgical consultation given the risk of complications from the sigmoid volvulus like ischemia or perforation.

2.  80 y/o white male
presents c/o acute onset
of severe abdominal pain,
abdominal distention,
and constipation. He
notes that he has had
occasional episodes of
severe pain in LLQ similar
to this but have resolved
on there own. Patient has
a history of chronic
constipation.
T: 99.0 P 100 R 16 BP 120/80
Gen: appears to be in pain,
HEENT: PERRL, NCAT,
oropharnyx clear
CV: RRR, no, m/r/g
Pulm: CTAB
Abd: TTP diffusely worse in
LLQ; distended abdomen Left
side > Right side; tympanic
abdomen to percussion
Ext: 2+ pulse, no c/c/e

4. •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 Sigmoid
Volvulus (Not seen Here)
•Left Flank Overlap Sign
•Northern Exposure Sign

5.  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.

6.  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

7.  Commonly seen in elderly patients with history of
chronic constipation, often neurologically debilitated.
 Complications: Colonic Ischemia, Perforation,
Peritonitis, Sepsis

8.  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