0:00

Okay. So here we have a non-contrast enhanced CT scan

0:05

of the abdomen pelvis in an elderly patient

0:07

who's having abdominal pain and distension.

0:10

Um, here we can see the liver is

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homogeneous without evidence of mass lesion.

0:13

As we come down, we'll see that there's a tiny

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baby spleen over there and a very atrophic

0:18

pancreas as well.

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A numerous simple cyst, some of which are

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dense, but no evidence of hydronephrosis.

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So this is indeed is an elderly patient, and you can

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see that they're very distended and that we have a very

0:29

air-filled loop of bowel here within the mid abdomen.

0:34

But we are going to interrogate this further.

0:36

The small bowel looks okay.

0:38

I would say go to coronal, right?

0:39

I told you colon on coronal.

0:41

That's my favorite view of the colon.

0:44

Here we can see the cecum is

0:45

in the right lower quadrant.

0:46

We have that little fatty

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orifice of the terminal ileum.

0:50

The ascending colon looks to be good.

0:53

We can go across the transverse colon.

0:55

It all has some oral contrast

0:57

in it, which I appreciate.

0:58

We don't usually get that in the ER these

1:00

days, all the way to the descending colon.

1:04

Coming down descending colon, and

1:06

then we come into a region of.

1:09

Swirling, we've got swirling,

1:11

oh, Houston, we have a problem.

1:13

We have swirling and swirling of that sigmoid

1:16

colon as we come across, and then up into very,

1:20

very distended loops of sigmoid colon hitting

1:23

all the way up to the left upper quadrant.

1:27

I mean, that's pretty dramatic.

1:28

I must say, and then down back into

1:31

our swirling, swirling loops of colon.

1:34

Sometimes it's a really good idea when you see so

1:37

much down in the sigmoid and then to the rectum.

1:40

When you see so much abnormality of the colon.

1:42

You may wanna look at your scout image, where you're

1:44

going to see just this huge distended loop of sigmoid

1:48

colon up into the left upper quadrant with distended.

1:52

Bowel proximal to it as well.

1:54

So this, my friends, is the sigmoid volvulus

1:57

frequently in our elderly patients and

2:00

something which can cause rapid obstruction

2:04

and distension in this patient population.