# Sigmoid Volvulus Causing Closed-Loop Obstruction and Surgical Management in a 16-Year-Old Female: A Case Report and Literature Review

## TL;DR

A 16-year-old girl with two episodes of sigmoid volvulus required surgery after non-operative methods failed, revealing a congenital band as a possible cause.

## Contribution

This case report highlights a rare pediatric presentation of sigmoid volvulus with a congenital band and successful surgical management.

## Key findings

- The patient had two episodes of SV confirmed by CT imaging and required surgical intervention.
- Intraoperative findings revealed a 360-degree anti-clockwise twist and ischaemic sigmoid colon.
- A congenital band was identified as a potential anatomical cause for the SV.

## Abstract

Sigmoid volvulus (SV) is a rare cause of bowel obstruction in children and has serious implications. In adolescents, diagnosis can be challenging due to nonspecific symptoms. Prompt diagnosis and intervention is critical to avoid complications such as sepsis or death. Treatment options for SV include non-operative and operative management, with immediate surgical intervention in those with ischaemia, perforation, or failed non-operative management. We present a 16-year-old female that presented to the emergency department twice with SV, complaining of vomiting and abdominal distention. An abdominal XR was conducted showing dilated loops of bowel. The diagnosis of SV was later confirmed by CT imaging. After failure of decompression with flexible sigmoidoscopy, the surgical team proceeded with open Hartmann's procedure. Intraoperatively, a long loop of ischaemic sigmoid colon was identified and twisted 360 degrees in an anti-clockwise direction. Surgical intervention via open Hartmann’s procedure was performed, and the patient had an uneventful recovery with ICU care and supportive management. Assessment of the specimen identified a congenital band, which seems to have led to SV.