Caecal and sigmoid volvulus in the same patient.

Case history The male patient (then aged 38 years) first presented in 1948 after an episode oflower abdominal pain and vomiting lasting several hours. Three similar attacks had occurred in the previous 14 years, 2 of which had required hospital admission. Physical examination was unremarkable but a barium enema showed a mobile caecum attached to a mesentery and a long redundant sigmoid loop, suggesting the possibility of recurrent volvulus. No treatment was given at that time. In 1971 he was admitted as an emergency with acute large bowel obstruction. A diagnosis of sigmoid volvulus was made on the radiological appearances and the colon decompressed by sigmoidoscopy. Two months later he required further admission for another episode of sigmoid volvulus, again treated conservatively by sigmoidoscopy, and one week later an elective sigmoid colectomy was performed. He made an uneventful recovery and was asymptomatic until September 1977 when he was admitted with acute large bowel obstruction of 24 hr duration. Sigmoidoscopy showed no abnormality, apart from a rather distended rectum. Plain X-rays revealed a caecal volvulus and laparotomy was performed. At