A 52 year old man is brought to hospital by ambulance complaining of 2 weeks of abdominal pain and constipation. He denies previous significant medical or surgical background.
On arrival he has a systolic blood pressure of 70mmHg and severe metabolic acidosis with pH 7.06 and lactate 14. Renal function.
is impaired with eGFR 26. The proximal large bowel as well as small bowel loops are dilated suggestive of an incompetent ileocaecal valve.
The distended bowel compresses the liver and displaces the gallbladder and spleen posteriorly. The abdominal aorta as well as the origins of the common iliac arteries and external iliac arteries are compressed by dilated bowel loops however remain patent and there is satisfactory flow distally to the common femoral and superficial femoral arteries.
There is narrowing of the proximal coeliac trunk likely due to compression by the median arcuate ligament. The coeliac trunk and its major branches are otherwise patent.
The SMA and IMA are patent. Comment: Acute sigmoid volvulus with severe bowel obstruction.
LITFL published a clinical update in Critical Care on 27 Jan 2026.
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