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So here we have the classic KUB from our patient,

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that we just looked at, showing this very distended

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loop of bowel within the mid abdomen, going all the

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way to the left upper quadrant with distended loops

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of proximal colon, consistent with our sigmoid volvulus.

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This is a classic on KUB.

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I personally love the KUB, and honestly,

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I teach KUBs, but no one really listens.

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So, um, at some point I could do a whole KUB course,

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but y'all wouldn't even watch it, but I love them.

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So anyway, this is a classic appearance of a

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sigmoid volvulus on a KUB, often referred to as the

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coffee bean sign, because the sigmoid volvulus will

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come up from the pelvis, and you'll have the fold

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of the loop in the midline, like a coffee bean.

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So let's talk about cecal volvulus versus sigmoid

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volvulus. Cecal volvulus is that younger population.

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19 00:00:51,675 --> 00:00:53,985 It's that developmental failure of peritoneal

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fixation of the cecum that makes it freely mobile,

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and it occurs in, you know, that variation is very

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common, but cecal volvulus is not that common.

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This is usually a surgical

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situation where the patient has to go for

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emergent surgery for detorsion of the cecum

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and usually a partial right hemicolectomy

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as well, as opposed to the sigmoid volvulus.

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The sigmoid volvulus is going to be in your older patients,

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people who have had a long history of constipation.

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Maybe they've been infirm, something

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where they have a neurogenic colon,

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so that the, uh, colon doesn't work as well

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as it should, that results in a very redundant

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sigmoid colon that can then tors, as we've

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seen in our case. These are usually treated with a

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sigmoidoscopy by our endoscopists, and insufflated,

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they're able to actually just blow enough

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air there and really push so that that detors itself.

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This population isn't the best surgical candidate,

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so as a result, um, a conservative

1:50

treatment for this is ideal.

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Unfortunately, the sigmoid

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volvulus will frequently reoccur.

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So we have patients who ileus, they will decompress

1:59

them, they ileus again. Surgery would be the

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best option for that patient,

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but if they're considered too sick for that,

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they will continually just do these sigmoid

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volvulus reductions and hope to change the

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patient's diet and medication in order to

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decrease the risk of constipation and the like.

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So on imaging on the KUB, we refer to this

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as the kidney bean, as opposed to the

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coffee bean. Again, younger population,

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older population. Surgical treatment,

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um, usually endoscopic treatment here.

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So those are your two classic colonic volvuluses that

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will result in obstruction of your patient.