Case 27 Answer

Findings: Large air filled “coffee bean” shaped structure in the mid-abdomen

Answer: Sigmoid volvulus

Sometimes these can be a little tricky (even on CT). I always try to remember where the obstruction would be for each. If you see air filled (dilated) colon, then it has to be a distal (ie sigmoid) obstruction. If you see dilated small bowel loops (sometimes quite big) but no real colon gas? Then think cecal. On CT definitely look for the swirling sigmoid colon loops yielding that twist-tie appearance. I have seen many more sigmoid than cecal.

reference: https://radiopaedia.org/articles/sigmoid-volvulus