AB021. SOH25_AB_114. Emergency Hartmann’s procedure of a sigmoid volvulus in a teenager: a case report of a surgical emergency

Background: Sigmoid volvulus is the most common cause of large bowel volvulus which can lead to large bowel obstruction. It typically presents in elderly male patients with abdominal pain and distention, vomiting, and constipation. However, it is highly unusual to see a sigmoid volvulus in patients of younger age. First-line investigation for sigmoid volvulus is a plain radiograph of the abdomen, and a computed tomography scan of the abdomen and pelvis (CTAP) typically follows to confirm diagnosis. Both imaging modalities have recognized classic findings which are highly suggestive of sigmoid volvulus.

Methods: We present the case of a 17-year-old adolescent male with a complex medical history and atypical anatomy who presented with abdominal pain, vomiting, and obstipation.

Results: CTAP revealed a dilated loop of bowel in the right upper quadrant consistent with a volvulus, however, it was noted that the exact location of the volvulus was difficult to discern due to the patient’s atypical anatomy. Exploratory laparotomy revealed a gangrenous volvulus sigmoid, and the patient ultimately underwent an emergency Hartmann procedure with permanent end colostomy.

Conclusions: There are very few reported cases of sigmoid volvulus in this demographic, and, to our knowledge, there are no other reported cases of a patient of this age undergoing an emergency Hartmann’s with permanent end colostomy. We aim to highlight the importance of including sigmoid volvulus in clinicians’ list of differentials despite atypical presentation, the unusual application of this life-changing procedure in such a young patient, and the significant improvement in the patient’s quality of life following surgery.

Keywords: Adolescent patient; atypical presentation; emergency Hartmann’s; radiology; sigmoid volvulus