An 80-year-old patient with abdominal pain and a plain film showing a coffee bean-shaped appearance; the most likely diagnosis is:

An 80-year-old patient with abdominal pain and a plain film showing a coffee bean-shaped appearance; the most likely diagnosis is:

• A. Small bowel obstruction
• B. Cecal volvulus
• C. Sigmoid volvulus
• D. Toxic megacolon

Answer: (C)

Recognizing a coffee bean appearance on an abdominal X-ray points to sigmoid volvulus. When the redundant sigmoid colon twists around its mesentery, the resulting massively dilated loop folds back on itself, outlining a single curved shape that resembles a coffee bean. This radiographic sign is especially characteristic in elderly patients who often have chronic constipation or long-term immobility, matching the scenario of an 80-year-old with abdominal pain. Other patterns don’t fit as neatly: a small bowel obstruction typically shows multiple dilated small-bowel loops with air-fluid levels; cecal volvulus can cause obstruction as well but usually shows a different loop position and a distinct displaced cecum rather than the classic coffee bean silhouette; toxic megacolon presents with diffuse, marked colonic dilation and systemic toxicity rather than a single large, bean-shaped loop.

Recognizing a coffee bean appearance on an abdominal X-ray points to sigmoid volvulus. When the redundant sigmoid colon twists around its mesentery, the resulting massively dilated loop folds back on itself, outlining a single curved shape that resembles a coffee bean. This radiographic sign is especially characteristic in elderly patients who often have chronic constipation or long-term immobility, matching the scenario of an 80-year-old with abdominal pain.

Other patterns don’t fit as neatly: a small bowel obstruction typically shows multiple dilated small-bowel loops with air-fluid levels; cecal volvulus can cause obstruction as well but usually shows a different loop position and a distinct displaced cecum rather than the classic coffee bean silhouette; toxic megacolon presents with diffuse, marked colonic dilation and systemic toxicity rather than a single large, bean-shaped loop.