Volvulus of sigmoid colon in a challenged adolescent: An unusual case report.

Tika Ram Bhandari,Sudha Shahi

doi:10.1016/j.amsu.2019.06.009

Abstract

Sigmoid volvulus is very uncommon cause of intestinal obstruction in pediatrics population withhigh rate of mortality. To date, few cases of sigmoid volvulus in children and association with several condition has been reported in literature, of them very few cases are with mental disability. We report a challenged (mentally disabled) 14-year old adolescent boy presented asan emergency with feature of complete bowel obstruction. Abdominal X-rays shows dilated loop of large bowel with inverted U shaped. Volvulus of sigmoid colon was found during laparotomy and successfully managed with resection of a redundant colon with colocolic end to end anastomosis. Sigmoid volvulus is relatively uncommon in children as compared to adults. Surgeons should be attentive of this rare entity, cause of large bowel obstruction to allow for early diagnosis and to enable better patient outcomes by reducing the morbidity and mortality.

Highlights

Volvulus is a rotation of part of the intestine around its mesentery, causing an intestinal obstruction
Sigmoid volvulus in mentally disabled patient may be associated with aerophagia and constipation that induce bowel distention
Having a adolescent with mental disability, diagnosis of acute abdomen is often challenging because they tend to present with nonspecific clinical presentation and history cannot be extracted correctly

Summary

Introduction

Volvulus is a rotation of part of the intestine around its mesentery, causing an intestinal obstruction. There are very few reported cases of volvulus in children with mental retardation to date [4,5]. Sigmoid volvulus in mentally disabled patient may be associated with aerophagia and constipation that induce bowel distention. Having a adolescent with mental disability, diagnosis of acute abdomen is often challenging because they tend to present with nonspecific clinical presentation and history cannot be extracted correctly. We report a case of sigmoid volvulus in a mentally disabled adolescent boy and treated with resection and anastomosis. This case has been managed in Universal College of Medical Sciences, Bhairahawa, Nepal Teaching Hospital by consultant General Surgeon and team. This case has been reported according to SCARE criteria for case reports [6]

Case presentation

Discussion

Conclusion

Findings

Ethical approval