Sigmoid Volvulus Following Mechanical Bowel Preparation in an Elderly Patient

A male in his 80s presented with abdominal distension and altered mental status after receiving a polyethylene glycol-based mechanical bowel preparation prior to a diagnostic colonoscopy. He had a history of dementia, atrial fibrillation, and thrombocytopenia. Physical exam was significant for peritonitis, and computed tomography imaging revealed pneumoperitoneum. The patient underwent an exploratory laparotomy, where a perforated sigmoid volvulus was identified. Sigmoid colectomy with end colostomy was performed. The post-operative course was complicated by delirium and upper gastrointestinal bleeding due to stress gastritis. The patient was eventually discharged back to his prior assisted-living facility in stable condition. This case highlights that in patients with risk factors for sigmoid volvulus, such as anatomic abnormality, advanced age, and dementia, mechanical bowel preparation may act as a precipitating stressor. It underscores the need for careful assessment of risks and benefits when considering colonoscopy in older adults, including consideration of risk factors for volvulus and bowel perforation following mechanical bowel preparation.