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Comments on ‘Coffee Bean Sign Detected by Visual Inspection’

      To the Editor:
      We read the article titled “Coffee bean sign detected by visual inspection,” written by Mizumoto,
      • Mizumoto J.
      Coffee bean sign detected by visual inspection.
      on a patient with sigmoid volvulus diagnosed by computed tomography (CT) through demonstration of the coffee bean sign. Although sigmoid volvulus is a rare colonic obstruction form worldwide, it is relatively common in Eastern Anatolia.
      • Atamanalp SS.
      Sigmoid volvulus: the first one thousand-case single center series in the world.
      My colleagues and I have a 1,046-case experience with sigmoid volvulus treated over a 55.5-year period between June 1966 and January 2022. This is the largest published single-center sigmoid volvulus series over the world. Therefore, we would like to offer some details on the diagnosis of sigmoid volvulus.
      In clinical presentation, volvulus triad, including abdominal pain and tenderness, left side asymmetrical distention (Figure 1A), and obstipation, are observed in 52%-99% of patients with sigmoid volvulus.
      • Atamanalp SS
      • Disci E.
      Sigmoid volvulus: diagnostic modalities and sigmoid gangrene.
      These clinical features were observed in 98.9%, 96.6%, and 92.5% of our patients, respectively. Conversely, as a less frequent finding, visible or palpable peristalsis (von Wahl sign) is reported to be between 7.3%-31.9% in sigmoid volvulus,
      • Uylas U
      • Gundogdu R
      Turgut E. A von Wahl sign in sigmoid volvulus patient with cerebrovascular disease.
      and was 7.8% in our series. However, coffee bean sign is known as a radiological image rather than a clinical finding. In sigmoid volvulus, the main x-ray sign is the presence of double-dilated sigmoid colon segments, which give the different shapes identified as coffee bean (Figure 1B), omega, horseshoe, or bird beak signs with 25%-90% of diagnostic accuracy rates,
      • Atamanalp SS
      • Disci E.
      Sigmoid volvulus: diagnostic modalities and sigmoid gangrene.
      68.2% in our cases. In addition to classical x-ray findings, the principally mesenteric whirl sign (Figure 1C) raises the diagnostic accuracy rate of CT to 90%-98% in sigmoid volvulus,
      • Atamanalp SS
      • Disci E.
      Sigmoid volvulus: diagnostic modalities and sigmoid gangrene.
      which was diagnostic in 97.6% of our patients. Finally, endoscopic finding of sigmoid volvulus is the presence of a spiral obstructive lumen usually in a 20-30 cm distance from anal verge (Figure 1D), which is diagnostic in 76%-100% of sigmoid volvulus cases.
      • Atamanalp SS
      • Disci E.
      Sigmoid volvulus: diagnostic modalities and sigmoid gangrene.
      This was determined in 98.7% of our cases. In our opinion and experience, in sigmoid volvulus, the current diagnostic procedure is CT or endoscopy, of which the latter also identifies the mucosal viability and aids in non-operative decompression, as was applied in the author's case.
      Figure
      Figure(A) Clinical appearance (D: left side asymmetrical distention). (B) Abdominal x-ray image (C: coffee bean sign). (C) Axial abdominal computed tomography image (S: dilated sigmoid segments, W: mesenteric whirl sign). (D) Endoscopic appearance (T: twisted obstructive lumen, V: viable mucosa, G: gangrenous mucosa).
      We congratulate the authors for their exploratory presentation and wait for their opinion on our comments.

      References

        • Mizumoto J.
        Coffee bean sign detected by visual inspection.
        Am J Med. 2021; 134: e388-e389
        • Atamanalp SS.
        Sigmoid volvulus: the first one thousand-case single center series in the world.
        Eur J Trauma Emerg Surg. 2019; 45: 175-176
      1. Web of Science. Sigmoid volvulus. Available at: https://www.webofscience.com/wos/woscc/summary/fdceb5df-4ef3-4044-bb3d-12f1fa14e332-36fd905a/relevance/1. Accessed May 10, 2022.

        • Atamanalp SS
        • Disci E.
        Sigmoid volvulus: diagnostic modalities and sigmoid gangrene.
        Eurasian J Med. 2021; 53: 166-167
        • Uylas U
        • Gundogdu R
        Turgut E. A von Wahl sign in sigmoid volvulus patient with cerebrovascular disease.
        Gazi Med J. 2021; 32: 476-478