A Twist on Adolescent Abdominal Pain in the Emergency Department

Abstract

Abdominal pain is a common complaint in pediatric patients in the emergency department (ED). Evolutions in clinical practice have shifted away from computed tomography (CT) to ultrasound (US) in assessing abdominal pain. However, ultrasound may not reliably rule out critical diagnoses. We present a 15-year-old male with intermittent suprapubic abdominal pain. Subsequent CT imaging showed swirling mesenteric vessels with a dilated sigmoid colon. In adolescent abdominal pain, sigmoid volvulus (SV), although rare, should be considered. Clinicians should avoid anchoring bias by maintaining a broad differential. Definitive care is surgical with resection to prevent recurrence.

Keywords: abdominal pain; adolescent; emergency medicine; pediatrics emergency; sigmoid volvulus.

Figure 1. Coronal view CT of the abdomen and pelvis

The white arrow is directed toward the swirling mesentery.

Figure 2. Scout view of the abdomen and pelvis

There is a large dilated loop of the colon suggesting bowel obstruction and sigmoid volvulus.

Figure 3. Transverse view CT of the abdomen and pelvis

The white arrow is pointing to the “swirl sign” suggestive of sigmoid volvulus.