Case challenge · Colorectal surgery / Emergency · teaching

Sigmoid Volvulus — Management Pathway · case challenge

Given a case, work through the care pathway step by step; the tool checks each choice and scores you. Decisions and basis are taken from this site's reviewed care pathways.

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Case #1Colorectal surgery / Emergency

📋 Case data

Ischemia/perforation/peritonitis?Ischemia/perforation/peritonitis/failed endoscopic detorsion

Data is taken from this pathway's reviewed node text. Work through the pathway step by step.

Step 1 / 1 · Ischemia/perforation/peritonitis?

Any ischemia/perforation/peritonitis?

💡 Sigmoid colon twisting on its mesenteric axis → closed-loop large bowel obstruction, the third most common cause of colonic obstruction; elderly men, chronic constipation, neuropsychiatric illness/bedbound, megacolon, prior abdominal surgery. Progressive distension + constipation/obstipation + colicky pain, vomiting is a late sign; severe pain/peritonitis = ischemia/perforation. Diagnosis: abdominal X-ray 'coffee-bean sign', CT 'whirl sign + bird-beak sign' (assess ischemia/perforation).

For teaching. Decisions and their basis are taken from this site's reviewed care pathways; for licensed clinicians/trainees, this does not replace clinical judgment or local protocols.