P0292 - Bimodal Presentation of Sigmoid Volvulus - A Case Series

Saisree Reddy Adla Jala, MD¹, Sudhir Reddy. Pasham, MD², Mathew Hasso, MD¹, Yamini Katamreddy, MD³, Nikitha Chellapuram, MD⁴, Lakshmi Deepika Gopalam, MD¹, Pragna Koleti, MD⁵, Anirudh Damughatla, DO⁶, Jonathan Hughes, BSN, MSN¹, Kenneth Luna, BSN, BA, RN¹, Mohsen Kheradpezhouh, MD^1
1Centinela Hospital Medical Center, Inglewood, CA; ²Guthrie Robert Packer Hospital, Sayre, PA; ³West Anaheim Medical Center, Anaheim, CA; ⁴Centinela Hospital Medical Center, Los Angeles, CA; ⁵Suburban Community Hospital, Norristown, PA; ⁶Detroit Medical Center/Wayne State University, Detroit, MI

Introduction: Sigmoid volvulus is a relatively uncommon cause of intestinal obstruction in children and adolescents. It usually occurs in the elderly with a mean age of 70 years. We present two cases: one adolescent and one elderly with challenging presentations of sigmoid volvulus.

Case Description/Methods: Case 1:

A 16-year-old female athlete presented with worsening abdominal pain for 2 days. While playing basketball, she suddenly started screaming with pain. She had nausea and non-bloody emesis. She had an episode of loose stools and passed flatus. Negative fever, chills, flank pain, pelvic pain, dysuria and vaginal discharge. Her abdominal pain had also subsided. She has no history of alcohol, tobacco or illicit drug use. Vitals were stable. No pertinent positives on examination. Labs were within normal limits. CT of the abdomen and pelvis with and without contrast demonstrated a narrowing and obstructing process within the mid-level transverse colon, dilatation and distension of the colon proximal to this level without contrast passed through into the proximal colon. Pelvic ultrasound noted pelvic fluid, otherwise negative. She underwent urgent colonoscopy and decompression of sigmoid volvulus.

Case 2:

A 70-year-old male with a past history of chronic constipation, dyslipidemia, hypertension, CAD s/p CABG presented with abdominal pain and constipation. He had been constipated for the past 1 month with severe lower abdominal pain over the past 3 days. He had nausea and non-bloody emesis. Negative fever or chills. No history of EGD, colonoscopy, abdominal surgery, alcohol, tobacco or illicit drug use. Vitals were stable. He was in moderate distress with a distended, tender abdomen. Labs: WBC 18.0, AST 42, ALT 33. CT abdomen and pelvis with and without contrast demonstrated findings of sigmoid volvulus. It was successfully decompressed via emergent colonoscopy. He continued to have abdominal distension and lower quadrant pain on the next day. Subsequent X-ray abdomen showed findings of sigmoid volvulus. Gastrograffin enema was performed to confirm if this was from the previous volvulus versus recurrence. It demonstrated persistent sigmoid volvulus with distension and obstruction. Subsequently, he underwent an exploratory laparotomy with resection of the sigmoid volvulus with end colostomy, Hartmann’s pouch.

Discussion: Early diagnosis and treatment are extremely crucial to avoid complications of sigmoid volvulus. Though uncommon in adolescents, it should be on the differential for intestinal obstruction.



Disclosures:


Saisree Reddy Adla Jala, MD¹, Sudhir Reddy. Pasham, MD², Mathew Hasso, MD¹, Yamini Katamreddy, MD³, Nikitha Chellapuram, MD⁴, Lakshmi Deepika Gopalam, MD¹, Pragna Koleti, MD⁵, Anirudh Damughatla, DO⁶, Jonathan Hughes, BSN, MSN¹, Kenneth Luna, BSN, BA, RN¹, Mohsen Kheradpezhouh, MD¹. P0292 - Bimodal Presentation of Sigmoid Volvulus - A Case Series, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.