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79 year old male with past history of:
- Parkinson's disease
- Coronary artery disease, status post CABG
- Monoclonal gammopathy of undetermined significance
Presented to the hospital with abdominal pain and distension along with constipation. his plain abdominal x-ray revealed :markedly distended sigmoid loop, which assumes a bent inner tube or inverted U-shaped appearance, with the limbs of the sigmoid loop directed towards the pelvis with loss of colonic haustra.
Contrast gastrographin enema examination revealed what is so-called bird's beak or bird-of-prey sign which represent a complete stenosis consistent with sigmoid volvulus. If the contrast enters the obstructed segment, spiraling of the mucosal folds may be seen (which is not the case here). Signs of bowel ischemia, such as thumbprinting, transverse ridging, and mucosal ulceration, could not be observed.
The volvuls could not be decompressed with sigmoidoscop, and patient was taken to the operating room where he was founfd to have sigmoid colon volvulus with ischemic changes at the neck of the volvulus along with dilated and ischemic sigmoid colon. Patient had sigmoid colectomy, left end colostomy and Hartmann pouch.
He was transfered to the intensive care unit post-operatively where he was extubated whitin the next 24 hours and spent an uneventful ICU course.
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