2002 Volume 35 Issue 5 Pages 547-550
An 88-year-old woman with constipation was admitted to our hospital because of vomiting and lower abdominal pain. Physical examinations revealed rebound tenderness at the right lower quadrant and abdominal distension. Scout abdominal films showed dilatation of the small intestine and the colon. Gastrografin enema showed the elongated sigmoid colon filled with a large amount of stool, which descended into the pouch of Douglas. The contrast medium did not pass the sigmoid colon. Abdominal computed tomography (CT) showed the lowest portion of the sigmoid was at the coccygeal level. Laparotomy revealed that the long sigmoid loop having a larger diameter was incarcerated in the unusually deep cul-de-sac, causing bowel obstruction. She underwent the obliteration of the cul-de-sac preceded by disgorgement of the sigmoid colon. There are no signs of recurrence during the follow-up of 15 months. Sigmoidocele can cause the incarcerated internal hernia, although it is ordinarily thought to be a cause of evacuatory disorders.
