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

BACKGROUND: Diagnostic difficulties are common in sigmoid volvulus. This diagnostic delay contributes to high morbidity and mortality. AIM: 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. METHODS: 519 patients with acute abdomen of non-traumatic origin were prospectively studied. RESULTS: 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%. CONCLUSION: 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.