Double sigmoid volvulus, a rare pathology of intestinal obstruction in children. Clinic Case report

Abstract

Introduction: Most intestinal obstructions in children are the result of postoperative adhesions. Those caused by congenital pathologies are rare, such as abnormal rotation that can cause a volvulus to develop. On account of the low frequency of colonic torsion, it is rarely considered in the differential diagnosis of acute or recurrent abdominal pain in children. Clinical case: 10-year-old male, without history of previous surgeries or trauma. His condition began 5 days prior to admission with vomiting, constipation and hyporexia. On physical examination: abdominal distension, decreased peristalsis and pain on palpation, without signs of peritoneal irritation. Leukocytosis was reported and imaging studies showed dilated large bowel loops, air-fluid levels without air in the rectal ampulla. Interventions and Results: An exploratory laparotomy was performed, finding a double volvulus at the level of the sigmoid colon with significant necrosis from the splenic angle of the colon to the rectum. Left Hartmann colectomy was performed. He was discharged after 11 days, without complications. Currently has a carrier of colostomy awaiting restitution of intestinal transit. Conclusions: Diagnosis of intestinal obstruction in children owing to volvulus can be difficult. Imaging studies help for diagnosis, and only exploratory laparotomy or laparoscopy are useful for resolution. The clinic and early diagnosis increase the success of non-surgical detorsion (either by contrast enema or colonoscopy), avoiding ischemia/necrosis, intestinal complications, and morbidity of emergent surgery.