<prompt> Sigmoid volvulus rotation occurs:ClockwiseAnticlockwiseBoth clock wise and anti clock wiseAxial in direction  <response>: Anti-clock wise 1197-Baily Love 24th 1192-B L 25thSIGMOID VOLVULUS - Most common cause of large bowel obstruction in indigenous black Africans. Rotation nearly always occurs in an anticlockwise direction Predisposing causes - Band of adhesions Peridiverticulitis overloaded pelvic colon, Long pelvic mesocolon, narrow attachment of pelvic mesocolon. Plain X-ray film of abdomen - The distended loop may assume a coffee bean shape. In caecal volvulus the concavity of the coffee bean points towards the right lower abdominal quadrants and in sigmoid volvulus it points towards the left lower quadrants. On barium enema, birds beak or ace of spades deformity with spiral narrowing of the upper end of the lower sigments is pathognomic 739-CSDT 11th 