Twisted

A 70 year old man presents with worsening pain in the left lower abdomen associated with an absence of bowel movements and passage of flatus for 6 days. He started vomiting just prior to admission.

His surgical and medical histories are unremarkable.

Select Relevant Investigations
Serum Electrolytes

Performed

Na+ 135 mEq/l (135 - 145)
K+ 4.2 mEq/l (3.5 - 5.5)
Cl- 101 mEq/l (95 - 105)
Full Blood Count

Performed

WBC/DC: 9,000/mm3 (4,600 - 11,000)
Hb: 14 g/dl (13.8 - 18 g/dl)
Platelets: 320,000/mm3 (150,000 - 450,000)
Upright X-Ray Abdomen

Performed

The X-Ray shows multiple air-fluid levels and dilated loops of large bowel. There is a markedly distended loop of sigmoid colon assuming an inverted U-shape.
CT Abdomen & Pelvis

Performed

The CT scan shows multiple dilated loops of colon with air-fluid levels and a central 'whirl' sign.

Select Relevant Management
Nasogastric tube
Start IV Fluids
Start IV Antibiotics
Endoscopic decompression