Sigmoid volvulus in young patients: Ą new twist on an old diagnosis

Abstract

According to the literature, sigmoid volvulus typically develops in patients of an older age with co-morbidities such as a psychiatric illness or a bed-bound chronic illness. Recent reports suggest that it should also be considered in young individuals without any preceding medical history. Abdominal roentgenography is a cheap and effective diagnostic modality that can avoid a delay in diagnosis. The treatment of colonic volvulus remains controversial and relies upon the procedure selected and the most appropriate therapeutic approach in terms of the clinical status of the patient, the location of the problem, the suspected existence or identification of peritonitis, bowel viability, and the expertise of the surgical team. Presented here are four cases of young male patients with sigmoid volvulus. All of the patients were diagnosed radiologically prior to surgical intervention. Two of the patients initially underwent an endoscopic procedure that succeeded in one and that failed in the other. Three of the patients underwent a laparotomy.

Keywords: Ischemia; laparotomy; obstipation; roentgenogram; sigmoid volvulus; strangulation; torsion.

Figure 1.

Classic coffee-bean sign on plain abdominal radiograph in Case No. 1.

Figure 2.

CT image of sigmoid volvulus in Case No. 4.

Figure 3.

CT image of sigmoid volvulus in Case No. 4.