A case report and literature review of sigmoid volvulus in children

Abstract

SV is a congenital anomaly and an uncommon diagnosis in children. Nevertheless, case series and case reports of SV are becoming more prevalent in the literature. Failure to recognize SV may result in life-threatening complications such as sigmoid gangrene/perforation, peritonitis, sepsis, and death. Thus, if the children have persistent and recurrent abdominal distention, abdominal pain, and vomiting, physicians should consider SV as a "do not miss diagnosis" in the differential diagnosis.

Sigmoid volvulus in an adolescent female: A case report

“…Sigmoid volvulus is a rare cause of mechanical intestinal obstruction in adolescent although in adults it's more prevalent especially in “volvulus belt” where high fiber diet is the norm [5] , [7] . Among children males to female ratio is of 3.5:1 [4] and this report was an adolescent female resident of a volvulus belt in Africa.…”

“…The case presented had an insidious onset presentation with vague abdominal symptoms of mild abdominal distension, obstipation with late episodes of vomiting. Being in a resource limited center, a radiograph obtained revealed distended bowel loops which is not the typical coffee bean appearance sign of sigmoid volvulus [4] .…”

“…Clinical presentation can be subacute progressive or acute fulminant volvulus with intense sudden abdominal pain or vague symptoms as for the subacute form as described by Hinshaw and Carter [10] . Physical signs are non-specific and diagnosis results in high clinical suspicion with complementary imaging studies like radiographs and CT scan [4] , [7] . The case presented had an insidious onset presentation with vague abdominal symptoms of mild abdominal distension, obstipation with late episodes of vomiting.…”

“…In imaging the whirlpool pattern due to dilated sigmoid colon around its mesenteric vessels and bird beak appearance of the afferent and efferent colonic segments are diagnostic. Abdominal radiographs are not-specific in adolescents and less useful in distinguishing volvulus from other disorders [4] , [5] . Absence of rectal gas, separation of sigmoid walls by adjacent mesenteric fat (split wall sign) and 2 crossing sigmoid transition points from a single location are other signs used to make diagnosis [4] , [5] .…”

“…Sigmoid volvulus is commonly reported in “volvulus belt” [2] . It's an extremely rare and potentially life threatening condition in the adolescent age group [4] .…”