Endoscopic Decompression & Surgical Management of Sigmoid Volvulus at Geetanjali Multispeciality Hospital, Wai

A Rare Emergency in a Young Patient — From Acute Bowel Obstruction to Definitive Surgery

The Case

On a Sunday afternoon, a 27-year-old woman presented to Geetanjali Multispeciality Hospital, Wai with a markedly distended abdomen.

She was restless and in significant pain, with:

• Multiple episodes of vomiting

• No passage of stool or flatus

• Gross abdominal distension

• A collapsed rectum on per-rectal examination

  
  

Although sigmoid volvulus was considered, the patient's young age and atypical X-ray appearance made the diagnosis challenging.

Initial Diagnosis: Acute Large Bowel Obstruction

An erect abdominal X-ray showed a grossly dilated large bowel loop on the left side, extending slightly across the midline.

The typical "coffee bean" appearance of sigmoid volvulus was not clearly evident.

Initial decompression was attempted using:

• Ryle's tube

• Flatus tube

While the patient's pain improved, the abdominal distension persisted.

A CECT abdomen and pelvis was therefore performed, which confirmed sigmoid volvulus, with no evidence of bowel ischemia or malignancy.

Emergency Endoscopic Decompression

Considering the confirmed volvulus, an emergency colonoscopy was performed.

Endoscopy revealed:

• Torsion of the distal colon at approximately 20 cm

• Markedly dilated sigmoid colon beyond the torsion

• Residual fecal matter within the dilated segment

When the endoscope was carefully negotiated through the twisted segment, there was a sudden gush of trapped flatus, confirming successful passage through the volvulus.

A flatus tube was placed under endoscopic guidance, followed by suction and decompression.

Result: Successful Endoscopic Detorsion

The colonic mucosa at and beyond the torsion appeared healthy, with no evidence of ischemic injury.

This allowed the team to avoid immediate emergency resection and stabilize the patient before definitive surgery.

Definitive Treatment: Sigmoid Colectomy

After allowing the bowel edema to settle, the patient underwent definitive surgery on Day 4.

Procedure

Sigmoid Colectomy with Colorectal Anastomosis

Importantly, the bowel could be reconnected directly and a stoma was not required.

For this young patient, avoiding a stoma also meant avoiding the potential morbidity and need for a subsequent stoma-reversal procedure.

From Emergency Decompression to Definitive Surgery

This case highlights the importance of a stepwise approach to sigmoid

volvulus when the bowel remains viable:

Diagnosis → Endoscopic decompression → Bowel recovery → Definitive sigmoid colectomy → Primary colorectal anastomosis

Timely endoscopic decompression helped relieve the obstruction and provided an opportunity to perform definitive surgery under more favorable conditions.

A Rare Presentation of Sigmoid Volvulus

Sigmoid volvulus occurs when the sigmoid colon twists around its mesenteric attachment, potentially causing a large bowel obstruction and, if blood supply becomes compromised, bowel ischemia.

While it is more commonly seen in older patients, this case presented in a 27-year-old woman, making the clinical presentation particularly unusual.

Early recognition is important because untreated volvulus can progress to bowel ischemia, perforation and other serious complications.

A Multidisciplinary Team Effort

The successful management of this complex emergency involved coordinated efforts from multiple specialists and teams.

Valuable guidance:Dr. Sachin Vaze – GI Surgeon

Intra-operative support:Dr. Manoj Lokhande – Senior Oncosurgeon

Endoscopic management:Dr. Siddhant Jayaghosh Kaddu

Anaesthesia support:Dr. Swapnil Motling

The GMH OT and Endoscopy teams also played an important role in the emergency management and definitive surgery.