Synchronous sigmoid-cecal volvulus: a rare case of large-bowel obstruction-a case report

Abstract

Introduction and importance: Large bowel obstruction caused by volvulus poses a life-threatening risk without immediate intervention. Sigmoid colon volvulus is predominant (43-75%), followed by cecal volvulus 10-52%). Synchronous double colonic volvulus is extremely rare, with limited documented cases in academic literature.

Case presentation: We report a case of synchronous volvulus involving the sigmoid colon and cecum in a 45-year-old male of the Toro tribe from Fort Portal city in western Uganda who presented with acute abdominal pain, distension, and complete constipation for 2 days, accompanied by five episodes of non-bloody feculent vomiting and anorexia.

Clinical discussion: Upon admission, the patient presented with stable vital signs and a mildly tender, tympanic, distended abdomen with absent bowel sounds. Plain radiographs revealed the characteristic "coffee bean" sign, indicative of sigmoid volvulus. Following optimization, laparotomy confirmed synchronous volvulus involving both the sigmoid and cecum. Subsequently, a total colectomy with end ileostomy was performed, after which the patient experienced an uneventful recovery.

Conclusion: Synchronous double colonic volvulus, a rare condition, is frequently overlooked clinically. Timely recognition and intervention are crucial to address diagnostic challenges and prevent potentially fatal outcomes.

Keywords: Case report; Cecum; Sigmoid; Synchronous; Volvulus.

Fig. 1

Plain erect abdominal radiograph of the 45-year-old male. Note the dilated large bowel loops (DL). Typical “coffee bean” sign, characteristic of sigmoid volvulus

Fig. 2

Intraoperative findings of the 45-old-year male: note the dilated sigmoid colon (DS), dilated cecum (DC), and twisting point (TP)

Fig. 3

Management schedule of a 45-year-old male over a period of 14 days