Bird's Beak Sign On Barium Enema

A patient presents to the emergency room with abdominal pain. An abdominal series shows a “bird’s beak” sign.

The most likely diagnosis is

A) Intussusception
B) Volvulus
C) Pyloric stenosis
D) Malrotation
E) Acute appendicitis

Answer and Discussion
The answer is B.

Sigmoid volvulus is a rare problem seen in children and adolescents. Volvulus occurs when a floppy sigmoid loop rotates around its base, producing arterial and venous obstruction of the affected segment, followed by rapid distention of the closed loop. Because the consequences can be life-threatening, sigmoid volvulus should be included in the differential diagnosis of acute and recurrent episodes of abdominal pain or bowel obstruction in children, especially if colonic dilation is seen on
radiographs.

Boys are more commonly affected than girls.

Symptoms can be either acute or recurrent. The most common symptoms are abdominal pain that is relieved by passage of stool or flatus, abdominal distention, and vomiting.

Radiographic evaluation often reveals colonic dilation. Barium enema often confirms or suggests the diagnosis and should be performed under fluoroscopic control; a “twisted-taper” or “bird’s-beak” appearance of the affected colon is characteristic.

The most common associated conditions include Hirschsprung’s disease and imperforate anus.

Management: Although sigmoid volvulus can resolve spontaneously, nonoperative management begins with fluid resuscitation and antibiotics, followed by barium enema detorsion of the sigmoid. Other nonoperative modalities include proctosigmoidoscopy and decompression by rectal tube.
Operative management most commonly consists of sigmoidectomy