Emptiness of the left iliac fossa: a new clinical sign of sigmoid volvulus.

Abstract

Diagnostic difficulties are common in sigmoid volvulus. This diagnostic delay contributes to high morbidity and mortality. This paper recognises visible or palpable emptiness of the left iliac fossa as a new clinical sign of sigmoid volvulus. Predictive accuracy of the sign was assessed in this study. 519 patients with acute abdomen of non-traumatic origin were prospectively studied. The new sign was present in 24 out of 86 patients (28%) with sigmoid volvulus. It was absent in all those who did not have sigmoid volvulus. The positive predictive value of the sign was 100%. Emptiness of the left iliac fossa is a valuable diagnostic adjunct. Positive sign is pathognomonic of sigmoid volvulus. Nevertheless, a negative sign warrants further investigations.