In their report, Foke van Delft and Elske Hoornenborg describe a 72-year-old Surinamese Hindustani man with diabetes, progressive abdominal pain, vomiting, shortness of breath, and watery stools without blood or mucus. He said he was chronically constipated for decades, and frequently used stimulant and osmotic laxatives.
The man’s abdomen was distended but not painful on palpation. Small bowel peristaltic movements were clearly visible from the outside in supine position (see video).
Radiography revealed a severely distended part of the colon in the right side of the abdomen, which looped in the right subphrenic space, between the liver and diaphragm. Suspecting sigmoid volvulus, the authors performed sigmoidoscopy, which revealed narrowing of the lumen with a whirl sign of the distal sigmoid colon without signs of mucosal ischemia.
After detorsion of the twisted colon segment, a decompression catheter was placed in the transverse colon and left in place for 24 hours. By 5 days later, the patient had only slight improvement in colon distension, indicating a longstanding motility disorder. However, the patient’s clinical situation improved significantly, and peristalsis was no longer visible. He was discharged with no follow up.
van Delft and Hoornenborg explain that sigmoid volvulus is a leading cause of acute colonic obstruction in South America, Africa, Eastern Europe, and Asia. The syndrome is most frequently seen in men and the elderly, and is associated with neuropsychiatric diseases, diabetes, and Chagas disease, which is endemic in Suriname.
The authors add that this interposition of the bowel, called Chilaiditi’s sign, is generally asymptomatic. However, it can easily be mistaken for free air and can lead to unnecessary surgical procedures.