2.  80 y/o white male T: 99.0 P 100 R 16 BP 120/80
presents c/o acute onset Gen: appears to be in pain,
of severe abdominal HEENT: PERRL, NCAT,
pain, abdominal oropharnyx clear
distention, and CV: RRR, no, m/r/g
constipation. He notes Pulm: CTAB
that he has had Abd: TTP diffusely worse in
occasional episodes of LLQ; distended abdomen Left
severe pain in LLQ similar side > Right side; tympanic
to this but have resolved abdomen to percussion
Ext: 2+ pulse, no c/c/e
on there own. Patient has
a history of chronic
constipation.

4. •Coffee Bean Sign:
•As closed loop of bowel distends
with gas, walls dilate, causing
coffee bean like appearance.
•Lose Haustral Markings
•Cleft
•Arises from Left Pelvis and points
towards RUQ (usually)
•Additional Findings in Sigmoid
Volvulus (Not seen Here)
•Left Flank Overlap Sign
•Northern Exposure Sign

5.  Left Flank Overlap Sign:
 Dilated Sigmoid Colon
overlaps Descending
Colon
 Can see descending colon
behind dilated bowel.
 Northern Exposure Sign:
 Dilated Sigmoid Colon
reaches superiorly to
Transverse Colon.

6.  IV & IV Fluids
 Analgesics & Antiemetics
 NG tube decompression
 Surgical Consult
 Reduction with endoscopy can by 85-95% successful
but has a 60% recurrence rate.
 Sigmoid Resection is definitive treatment

7.  Commonly seen in elderly patients with history of
chronic constipation, often neurologically debilitated.
 Complications: Colonic Ischemia, Perforation,
Peritonitis, Sepsis

8.  Feldman, Deborah. “The Coffee Bean Sign” Radiology
http://radiology.rsna.org/content/216/1/178.full
 www.diagnosticimaging.com/display/article/113619/141
0628
 http://www.learningradiology.com/notes/ginotes/sig
moidvolvpage.htm
 Schwartz, David. Emergency Radiology. 2000. pg 527-
529.
 Tintanelli’s Emergency Medicine: A Comprehensive
Study Guide. Chapter 79 Intestinal Obstruction