Synchronous caecal and sigmoid volvulus: a surprise twist.

Traditionally, caecal volvulus (CV) and sigmoid volvulus (SV) have been thought of as largely separate clinical entities with distinct clinical features, radiological findings and treatment strategies. We present a rare case of synchronous CV and SV. To our knowledge, this represents only the ninth such case in the literature. This posed a diagnostic challenge as the seemingly textbook features of SV, such as the classical 'coffee-bean' sign on plain abdominal X-ray, masked the simultaneous occurrence of CV which only became apparent after the patient continued to deteriorate despite the successful endoscopic decompression of the SV. The diagnosis of SV should be made cautiously, with a period of close clinical observation post-intervention and a low threshold for re-evaluation should symptoms persist or recur to ensure accurate diagnosis.