Acute Presentation of Sigmoid Volvulus in a Patient in the Fourth Decade: A Case Report

Abstract

Background: Sigmoid volvulus is a recognised cause of large bowel obstruction, but its presentation in younger adults is reported less commonly than in elderly patients. This case describes the acute presentation, diagnostic findings, operative management, and early postoperative course of sigmoid volvulus in a patient in the fourth decade of life. Case Presentation: A 41-year-old male carpenter presented with severe abdominal pain of one day's duration and a three-month history of constipation. He initially did not undergo the advised abdominal radiograph and later returned with worsening pain and progressive abdominal distension, which increased from 76 cm to 82 cm within 24 hours. His history included chronic alcohol consumption for 20 years and smoking, with no known chronic medical illness, previous surgery, or drug or food allergy. On examination, he was tachycardic, with a pulse rate of 115 beats per minute, blood pressure of 140/95 mmHg, oxygen saturation of 94% on room air, and respiratory rate of 18 cycles per minute. Abdominal examination revealed diffuse tenderness, distension, and guarding, with sluggish bowel sounds and a roomy rectum with faecal staining. An erect abdominal X-ray demonstrated a dilated colon with the classic coffee bean sign, without radiological evidence of perforation. Ultrasonography showed mild to moderate ascites and excessive reverberation artefacts. Midline laparotomy revealed a dilated and inflamed sigmoid colon measuring approximately 15 × 10 cm. Manual derotation and decompression were unsuccessful; therefore, resection of the redundant sigmoid colon with primary colorectal anastomosis was performed. Postoperatively, the patient remained stable, was extubated after 6 to 8 hours, passed flatus and stool on postoperative day 3, and was shifted to the ward after 5 days. Conclusion: This case emphasises the importance of early clinical suspicion and imaging in patients with abdominal pain and chronic constipation.