Don’t Get It Twisted: A Case of Pediatric Sigmoid Volvulus Presenting as Lower Back Pain

Sigmoid volvulus (SV) is a closed‑loop large bowel obstruction that is exceedingly uncommon in children and adolescents. Early diagnosis is essential, as progressive torsion of a redundant sigmoid colon around its mesentery leads to venous congestion, arterial compromise, and eventual bowel necrosis and perforation if untreated. Pediatric SV presents with crampy abdominal pain, distension, vomiting, and obstipation; however, low back pain has not previously been described as a primary presenting symptom. This report describes the case of a 17‑year‑old boy who presented with a chief complaint of severe bilateral lower back and moderate bilateral hip and flank pain, as well as a previous bout of associated mild suprapubic discomfort that subsided prior to arrival. He was subsequently diagnosed with SV on computed tomography and was successfully managed with emergent endoscopic detorsion followed by elective robotic sigmoid resection.