Pediatric Sigmoid Volvulus

  • Etiology: Chronically dilated loops of bowel cause sigmoid colon to twist on its mesentery (the sigmoid mesocolon) which leads to bowel ischemia
  • Imaging AXR: Coffee bean sign
  • Imaging Enema: Beak sign at the transition zone of the volvulus with contrast unable to go beyond
  • DDX:
  • Complications: Bowel obstruction
  • Treatment:
  • Clinical:
    — Uncommon in children
    — Most commonly seen in patients with cerebral palsy or other chronic conditions

Radiology Cases of Sigmoid Volvulus

AXR of pediatric sigmoid volvulus
AXR AP shows a large dilated loop of colon in the midline of the abdomen folded back upon itself (coffee bean sign).
AXR and enema of sigmoid volvulus
AXR AP (above) shows the colon to be massively dilated throughout its length and there is a suggestion of a ‘bean’ sign in the middle of the abdomen. Early (below left) and later (below right) lateral images from an enema shows an inability to opacify the entire colon with contrast and the presence of a beak sign in the sigmoid colon.