The Coffee Bean Sign

An 87-year-old man presents with constipation and abdominal pain. A plain radiograph reveals a classic sign. Can you diagnose this Surgical Emergency?

Cecal volvulus


An 87-year-old man with chronic kidney disease, hypertension, and atrial fibrillation presented to the emergency department with a 3-day history of constipation and lower abdominal pain. Physical examination was notable for abdominal distention and tenderness to palpation of the right lower quadrant without rebound or guarding. A plain radiograph of the abdomen is shown. What is the most likely diagnosis?

What is the most likely diagnosis?

Cecal volvulus
Constipation
Hiatal hernia
Ogilvie’s Syndrome (acute colonic pseudo-obstruction)
Small bowel obstruction

Abdominal pain, Bowel Obstruction, Cecal volvulus, Coffee Bean Sign, Geriatrics

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