Gangrenous sigmoid volvulus with minimal clinical signs in an elderly patient: a case report

Abstract

Introduction:

Sigmoid volvulus is the twisting of a redundant sigmoid colon around its mesenteric axis, either clockwise or counterclockwise, resulting in large bowel obstruction. It is a common cause of intestinal obstruction in African and Asian countries. In Ethiopia, sigmoid volvulus (SV) frequently presents with recurrent episodes of large bowel obstruction.

Method: This case was prepared using the 2025 SCARE checklist. The patient’s medical chart was reviewed and summarized in this report. AI is used for rewriting.

Clinical Importance:

Elderly patients may not manifest classical signs of bowel ischemia or gangrene, such as tachycardia, fever, abdominal tenderness, or leukocytosis, making diagnosis and timely intervention challenging compared to younger individuals with typical presentations.

Case Presentation:

An 82-years-old male presented with recurrent abdominal pain and failure to pass feces. He had experienced three previous similar episodes, managed conservatively with rectal tube deflation, after which he was discharged. On this admission, his vital signs, abdominal examination, digital rectal examination, and white blood cell count did not suggest bowel ischemia. Rectal tube deflation was attempted but failed, prompting exploratory laparotomy. Intraoperative, the sigmoid colon was found to be grossly distended, gangrenous, and twisted 360 degrees, with gangrene extending to the proximal one-third of the rectum. En bloc resection with Hartmann’s procedure was performed. The patient was managed postoperatively with intravenous antibiotics and stoma care education. He was discharged on the seventh postoperative day without complications such as surgical site infection or stoma-related problems.