A case of sigmoid volvulus

Clinical presentation

A 53-year-old man was admitted with a 2-week history of bowel obstruction on a background of gradually worsening dyspeptic symptoms associated with vomiting and weight loss. He was under regular gastroenterology review for Barrett's oesophagus and had a recent endoscopic diagnosis of megaduodenum (mainly D1 dilatation) confirmed by barium study (figure 1). He was also known to have bladder emptying problems and an enlarged bladder. His mother died at age 28 due to 'megacolon', and he has a monozygotic twin brother with Barrett's oesophagus.

Figure 1

Barium meal and follow through confirmed dilation of the duodenum with normal small bowel transit.

Abdominal X-ray showed marked large bowel dilatation (figure 2) and urgent CT scan of the abdomen and pelvis confirmed sigmoid volvulus (figure 3).

Figure 2

Urgent abdominal X-ray with prominent large bowel dilatation.

Figure 3

Representative axial image from urgent CT scan  of the abdomen and pelvis indicating sigmoid volvulus.

Despite two attempts at endoscopic decompression, he eventually underwent Hartmann's sigmoidectomy. His postoperative recovery was delayed by prolonged ileus requiring nasogastric drainage and parenteral nutritional support. He was discharged on the 19th day postoperatively.

Question

Aside from the immediate volvulus presentation, should any other diagnosis be considered?

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