Figure it out fridays 

62 year old male, with history of laparoscopic hartmann’s procedure 1 year ago due to recurrent sigmoid volvulus, presented with a prolapsed and ischemic colostomy

Past medical history of DM and HTN

On the morning of admission, the patient’s carer noticed that he had a congested and prolapsed stoma. 

On presentation to the emergency department, he was hemodynamically stable. Abdominal examination revealed an ischaemic, dilated stoma site, which was prolapsed to 15 cm (Fig. 1). There was also mild tenderness on deep palpation in the supra-pubic region.

Labs: white cell count of 11.4, sodium of 125 and a lactate of 3.04. 

A CT-abdomen pelvis done.  

​

What do you think is the diagnosis?

A. Caecal volvulus

B. Sigmoid volvulus

C. Parastomal hernia

D. Intussusception

E. Tumor mass