Sigmoid volvulus in an adolescent girl: staged management with emergency colonoscopic reduction and decompression followed by elective sigmoid colectomy

Abstract

A case of acute sigmoid volvulus in a 14-year-old adolescent girl presenting with acute low large bowel obstruction with a background of chronic constipation has been presented. Abdominal radiograph and CT scan helped in diagnosis. She underwent emergency colonoscopic detorsion and decompression uneventfully. Lower gastrointestinal contrast study showed very redundant sigmoid colonic loop without any transition zone and she subsequently underwent elective sigmoid colectomy with good outcome. The sigmoid volvulus should be considered in the differential diagnosis of paediatric acute abdomen presenting with marked abdominal distention, absolute constipation and pain but without vomiting. Plain abdominal radiograph and the CT scan are helpful to confirm the diagnosis. Early colonoscopic detorsion and decompression allows direct visualisation of the vascular compromise, assessment of band width of the volvulus and can reduce complications and mortality. Associated Hirschsprung's disease should be suspected if clinical and radiological features are suggestive in which case a rectal biopsy before definitive surgery should be considered.

Figure 1

(A) Abdominal radiograph at presentation. (B) Postcolonoscopic reduction.

Figure 2

Abdominal CT scan: cross-section. Note long twist from pelvis to lower abdomen.

Figure 3

Abdominal CT scan: coronal and sagittal views confirming sigmoid volvulus.

Figure 4

Colonoscopic views of the distal and proximal ends of the sigmoid volvulus.

Figure 5

Lower gastrointestinal contrast showing redundant long loop of sigmoid colon.