<prompt> Diagnosis of the given XRay of abdomen:Small intestine obstructionPneumointestinalisSigmoid volvulusIntussusception  <response>: Ans. c Sigmoid volvulusRef: SRB manual of Surgery, 4th ed. 1329 The given image shows coffee bean sign, which is seen in sigmoid volvulus. Sigmoid volvulus is a cause of large bowel obstruction and occurs when the sigmoid colon twists on the sigmoid mesocolon.Clinical Presentation Constipation Abdominal bloating Nausea andor vomitingCauses Chronic constipation andor laxative abuse Fibre-rich diet especially in Africa Chagas disease especially in South AmericaTreatment Rectal tube insertion is successful in treating 90 of cases. The most serious complication is bowel ischaemia. 