Year 2025 / Volume 117 / Number 9
Letter
Reply to the comments on “Coffee bean sign, steel pan sign and whirl sign in sigmoid volvulus”

530-531

DOI: 10.17235/reed.2024.10571/2024

Akira Hokama, Atsushi Iraha, Kazuko Yamamoto,

Abstract
We thank Prof. Atamanalp and colleagues for their interest and valuable comments on our article. The authors have highlighted important considerations in the diagnosis of sigmoid volvulus (SV). We would like to respond to their comments. Firstly, although we agree with their opinion that CT, MRI, and endoscopy are more reliable diagnostic tools than plain radiography, we still emphasize that diagnostic imaging for SV is initially based on plain radiography, as recommended by the WSES consensus guidelines. Since SV is the third most common cause of colonic obstruction worldwide, the accessibility of plain radiography is crucial. Among the many plain radiographic signs of SV, Levsky et al. reported that the most sensitive signs were absence of rectal gas, followed by inverted-U appearance and coffee bean sign. Understanding these signs may lead to early detection of SV and further CT evaluation for ischemia or perforation. Despite the high value of plain radiography, there is a global tend to use CT instead from the outset. Secondly, we agree with their opinion that endoscopy is not only a therapeutic, but also a diagnostic procedure to assess mucosal viability. In addition, we believe that endoscopy is also useful in ruling out other obstructive lesions, including colorectal neoplasia and complicated sigmoid diverticular disease. In the clinical setting, endoscopy is performed after the diagnosis of SV by plain radiography or CT and serves as the first line of decompression of SV when ischemia or perforation is not suspected. Finally, we congratulate Prof. Atamanalp and colleagues for their dedicated contribution to the large-scale SV studies in Eastern Anatolia, Turkey, where SV is endemic.
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References
1.Hokama A, Iraha A. Coffee bean sign, steel pan sign and whirl sign in sigmoid volvulus. Rev Esp Enferm Dig 2024;116:114-5. DOI: 10.17235/reed.2022.9262/2022
2.Atamanalp SS. Endoscopic decompression of sigmoid volvulus: Review of 748 patients. J Laparoendosc Adv Surg Tech 2022;32:763-7. DOI: 10.1089/lap.2021.0613
3.Tian BWCA, Vigutto G, Tan E, et al. WSES consensus guidelines on sigmoid volvulus management. World J Emerg Surg 2023;18:34. DOI: 10.1186/s13017-023-00502-x
4.Levsky JM, Den EL, DuBrow RA, et al. CT findings of sigmoid volvulus. AJR Am J Roentgenol 2010:194:136-43. DOI: 10.2214/AJR.09.2580
5.Atamanalp SS, Peksöz R, Dişçi E. Sigmoid volvulus and ileosigmoid knotting: An update. Eurasian J Med 2022;54(Suppl1):91-6. DOI: 10.5152/eurasianjmed.2022.22310
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Hokama A, Iraha A, Yamamoto K. Reply to the comments on “Coffee bean sign, steel pan sign and whirl sign in sigmoid volvulus”. 10571/2024


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Publication history

Received: 30/05/2024

Accepted: 02/06/2024

Online First: 14/06/2024

Published: 15/09/2025

Article Online First time: 15 days

Article editing time: 473 days


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