Unusual "twister"-like appearance of a sigmoid volvulus on computed tomography.

ence of a distorted intestinal segment, but this is uncommon in older patients. We report here an exception to this rule of thumb. An 87−year−old woman had been admit− ted with a 2−day history of abdominal pain. She had a history stretching back over several years of senile dementia. Clinical and laboratory examinations led to a provisional diagnosis of ileus (the C− reactive protein was within the normal range and the white blood cell count was 12.1 ” 109/L). Computed tomography re− vealed an impressive image of a volvulus of the sigmoid colon. The patient there− fore underwent laparotomy under peri− operative antibiotic cover [1], which con− firmed the preoperative diagnosis. The sigmoid colon was distorted but there was no evidence of disturbance of mesen− teric perfusion. This allowed untangling of the extra−long sigmoid loop, and resec− tion was not required. In addition, the co− lon was decompressed by transanal placement of a decompression tube. Sub− sequently, the sigmoid was fixed with some stitches to the left parietal perito− neum, the inner surface of the abdominal wall. The patient was monitored postopera− tively for 3 days in the surgical intensive care unit. She developed a temporary postoperative psychotic disorder (with disorientation and deterioration in her dementia) but otherwise her postopera− tive course, in terms of reuptake of oral fluids and food and wound healing, was uneventful. The patient was discharged on the 10th postoperative day with no further complaints. This short report presents extremely unu− sual computed tomographic images of a rare “twister”−like structure in the left lower abdomen (l" Fig. 1, 2; Videos 1, 2) [2], which turned out to be an intestinal volvulus caused by an extra−long sigmoid colon. The images greatly facilitated the elucidation of the clinical diagnosis of an ileus by eliminating other much more likely potential diagnoses (given this pa− tient’s age), such as obstructing tumorous lesions or disturbances of mesenteric per− fusion.