A rare cause of intestinal obstruction in children: Sigmoid volvulus

Sigmoid volvulus (SV) presents as a significant cause of intestinal obstruction, predominantly observed in adults. However, its occurrence in pediatric populations is exceedingly rare. We present an 11-year-old female case admitted with complaints of abdominal pain, inability to pass stool for eight days, and vomiting. Her abdomen was distended and she was on respiratory distress. Abdominal plain radiograph revealed grossly dilated bowels. The computed tomography confirmed the diagnosis of SV. Due to the patient's respiratory instability and prolonged symptom duration emergency laparotomy was performed. Intraoperatively, a 40-cm long and 15-cm wide sigmoid colon was found 360 degrees twisted around its mesentery, without evidence of perforation. After manual detorsion, full-thickness biopsies were taken. The postoperative recovery was uneventful, with a histopathological report revealing a normal ganglionic colon. After a few weeks of outpatient follow-up, an elective laparoscopic sigmoidectomy was performed to eliminate the high risk of recurrence. The patient remained asymptomatic and her chronic constipation improved without medication during a one-year follow-up. In conclusion, SV may present with the signs of intestinal obstruction and must be considered in the differential diagnosis of acute abdomen. Early recognition and appropriate surgical intervention are crucial for favorable outcomes in such cases.