2011 Volume 15 Issue 1 Pages 83-90
A 42-year-old female patient visited our hospital with the complaint of acute lower abdominal pain and vomiting after meal. Plain abdominal X-ray and abdominal CT scanning seemed to show the coffee-bean sign in the mid-lower abdomen. She tried to undergo emergent colonoscopy reduction in the diagnosis of sigmoid colon volvulus. Although colonoscope was inserted to the ascending colon, mid-lower intestinal gas was not disappeared completely. MRI imaging afterward showed increased coffee-bean shaped giant gas and increased ascites. Then she underwent emergent laparotomy in the diagnosis of strangulation ileus. A small amount of serous ascites was found. The fixation of the cecum to the retroperitoneum was poor and the ileocecum was twisted 360degree counterclockwise but was not found to be necrotic. An ileocecal resection was performed to avoid the recurrence of the cecal volvulus. The postoperative course was uneventful. Although most of the cases with coffee-bean sign are volvulus of sigmoid colon, volvulus of cecum should be remembered when large intestinal gas does not disappear after colonoscopy reduction.
