Sigmoid volvulus in a child with Autism Spectrum Disorder

Abstract

Sigmoid volvulus is an uncommon cause of abdominal pain and obstruction in the pediatric population, with most physicians not considering it in the differential diagnosis. History of Autism Spectrum Disorder (ASD) with concomitant volvulus of the sigmoid colon is a rare occurrence that presents with communication challenges that can impair diagnosis and treatment. This is the case of a 10-year-old male patient with ASD who presented with abdominal pain, obstipation, and vomiting. Plain abdominal radiograph showed an intestinal obstructive pattern subjective for sigmoid volvulus. The patient was successfully decompressed with a nasogastric and rectal tube and underwent an open sigmoidectomy with end-to-end coloproctostomy during the same admission. Communication impairment made it difficult to assess subjective parameters such as pain, and nausea. On post-operative day #8 extensive pneumoperitoneum was observed on a chest radiograph and the patient was taken for emergency laparotomy that resulted in a partial colectomy with end colostomy. Sigmoid volvulus is an exceptionally rare occurrence in the pediatric population. High suspicion should be kept for prompt diagnosis and treatment in patients with ASD. Particular attention to objective information such as physical examination, vital signs, laboratories, and imaging studies should be maintained since communication is usually impaired.