A case of sigmoid volvulus.
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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.gutjnl;gutjnl-2017-315465v1/F1F1F1Figure 1Barium 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).gutjnl;gutjnl-2017-315465v1/F2F2F2Figure 2Urgent abdominal X-ray with prominent large bowel dilatation.gutjnl;gutjnl-2017-315465v1/F3F3F3Figure 3Representative 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?