A 13-year-old Arabian girl reported to the emergency department in Bahrain with complaints of colicky abdominal pain, constipation and vomiting that had been present since 3 days. She had not experienced constipation before this.
Physical examination showed a distended tympanic abdomen with no tenderness. However, was soft all over. Bowel sounds of the patient were sluggish. For further evaluation a digital rectal examination was done which revealed an empty rectum. A plain radiograph of the abdomen showed a hugely dilated loop of bowel with an appearance of a coffee bean that extended from the patient’s pelvis.
The findings on the abdominal radiograph were consistent with the diagnosis of sigmoid volvulus. A rectal tube was successfully inserted which gave the 13-year-old immediate relief from her symptoms.
She was admitted to the paediatric surgical ward and started on intravenous antibiotics. In addition, a nasogastric tube was also inserted. The next day the patient was asymptomatic, however, findings on the contrast enema showed the twist to be evident associated with incomplete obstruction. She was then referred for endoscopic decompression of the volvulus under general anaesthesia. The twist caused venous congestion and was reduced successfully.
24 hours post endoscopic reduction, a rectal tube was left in place. She was asymptomatic and on her parents request was discharged to travel back to her native country.
A month later, she returned to Bahrain from her native country and presented with similar symptoms. The radiological findings were similar as the previous findings. However, this time the volvulus could not be compressed and she had to undergo sigmoidectomy with primary anastomosis. She developed paralytic ileus postoperatively, however, that resolved after 10 days. She presented with no symptoms at her 1-year follow-up after resection.
References
Haider, F., Al Asheeri, N., Ayoub, B., Abrar, E., Khamis, J., Isa, H., … & Al Hashimi, F. (2017). Sigmoid volvulus in children: a case report. Journal of medical case reports, 11(1), 1-5.
