An 81-year-old man who had been diagnosed as having situs inversus totalis and had suffered from repeated episodes of sigmoid volvulus was admitted with a history of right upper quadrant abdominal pain. Physical examination showed no evidence of peritoneal irritation. A plain radiograph of the abdomen showed a markedly dilated sigmoid colon with an inverted U-shaped appearance. Abdominal CT showed situs inversus totalis, no free air, no ascites, and a whorled appearance of the sigmoid mesentery, with dilated bowel loops. Based on these findings, the patient was diagnosed as having recurrence of sigmoid volvulus. Colonoscopy performed for repositioning showed converging mucosa signifying the distal point of the torsional obstruction, and a dilated section of the bowel with gas and feces proximal to the obstruction in the sigmoid colon. After endoscopic decompression, colonoscopy showed no evidence of mucosal ischemia. We treated this case successfully as we would have a case of sigmoid volvulus without situs inversus.
