The coffee bean sign

An 89-year-old woman presented to our emergency department (ED) with a 4-day history of abdominal pain and vomiting. The physical exam revealed hypotension and a distended abdomen with generalized tenderness. Laboratory studies revealed hyperkalemia and elevated creatinine, lactate, and troponin. Given her hemodynamic instability, an emergent noncontrast abdominal computed tomography (CT) was obtained (Figs. 1 and 2). The patient was diagnosed with sigmoid volvulus. Sigmoid volvulus is the third leading cause of large bowel obstruction, behind cancer and diverticulitis [1]. Her CT scan revealed marked distention of the sigmoid colon and rectum with abundant stool in the rectum. The coronal image demonstrated a twisted loop of sigmoid with two air-filled compartments and a central double wall ending at the point of the twist, referred to as the “coffee bean” sign. This has also been observed in abdominal X-rays and is highly suggestive of sigmoid volvulus [2]. The diagnostic accuracy of plain X-rays ranges from 30 to 90%, depending on the experience of the