ZyraDoc #25 - August 26, 2026

An 78-year-old institutionalized man presents with progressive abdominal distension, obstipation, severe crampy colicky abdominal pain, and vomiting.

Abdominal radiograph displays a classic 'coffee bean sign' with a hugely dilated inverted U-shaped loop of bowel originating from the pelvis.

Physical examination reveals mild abdominal tenderness without peritoneal signs, fever, or leukocytosis, and the team considers emergency laparotomy as first-line therapy.

Case Summary

Clinical Focus:

An 78-year-old institutionalized male presents with large bowel obstruction secondary to uncomplicated sigmoid volvulus.

Diagnostic Features of Sigmoid Volvulus:

Triad: Abdominal pain, severe abdominal distension, and obstipation
Abdominal X-ray: 'Coffee bean sign' or 'bent inner tube sign' pointing toward the right upper quadrant
Risk factors: Elderly, institutionalized, chronic constipation, neurodegenerative disease

In the absence of bowel gangrene or peritonitis, non-operative endoscopic decompression is the primary initial intervention.

Here is the Management Strategy:

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