# Cardiac Tamponade and Arrest Secondary to Simultaneous Gastric and Sigmoid Volvulus With Sigmoid Obstruction From an Incarcerated Left Inguinal Hernia

## TL;DR

A rare case of simultaneous gastric and sigmoid volvulus caused severe heart compression and cardiac arrest, highlighting the need for rapid diagnosis and treatment.

## Contribution

This paper presents a unique case of combined gastric and sigmoid volvulus with herniation leading to cardiac tamponade and arrest.

## Key findings

- Simultaneous gastric and sigmoid volvulus with herniation can cause cardiac tamponade-like physiology.
- The patient's condition resulted in severe hemodynamic compromise and death despite resuscitation efforts.
- Early imaging and clinical suspicion are critical for managing complex obstructive shock cases.

## Abstract

Sigmoid volvulus is a well-documented cause of large bowel obstruction, often occurring in elderly or neurologically impaired individuals. While typically straightforward in diagnosis, concurrent anatomical abnormalities can obscure the clinical presentation and lead to catastrophic outcomes. This report presents an exceptionally rare case of simultaneous gastric and sigmoid volvulus with incarceration of the sigmoid colon within a left inguinal hernia, resulting in cardiac tamponade-like physiology and cardiac arrest.

A 78-year-old man with cognitive impairment and bilateral inguinal hernias was found in pulseless electrical activity (PEA) arrest at his group home. Return of spontaneous circulation (ROSC) was achieved twice following cardiopulmonary resuscitation. On arrival at the emergency department, the patient was profoundly unstable, with a markedly distended abdomen and tense bilateral hernias. Computed tomography revealed a distended sigmoid colon consistent with volvulus, with the proximal sigmoid incarcerated within the left inguinal hernia. The entire stomach was also herniated into the thoracic cavity, causing severe left atrial compression. Laboratory results showed a serum lactate level of 18 mmol/L, consistent with global tissue hypoperfusion. Emergent exploratory laparotomy revealed a torsed, ischemic sigmoid colon and gastric volvulus with mechanical cardiac compression. Surgical management included reduction of the sigmoid and hiatal hernias, sigmoid colectomy with end colostomy, and anterior gastropexy. Despite aggressive resuscitation, the patient developed refractory metabolic acidosis and multiorgan failure, culminating in death on postoperative day one.

This case demonstrates a rare and lethal confluence of gastrointestinal and cardiovascular pathophysiology. The sigmoid volvulus and gastric herniation produced both obstructive and compressive hemodynamic compromise, culminating in circulatory collapse. The patient’s outcome was further worsened by the physiologic insult of preceding cardiac arrests and the systemic inflammatory state characteristic of post-cardiac arrest syndrome.

This case highlights the importance of early imaging and a high index of clinical suspicion for complex anatomic causes of obstructive shock. Simultaneous gastric and sigmoid volvulus with herniation can produce catastrophic hemodynamic consequences, including cardiac tamponade physiology. Multidisciplinary coordination and rapid intervention are essential, although prognosis remains poor in patients presenting with severe ischemia and post-resuscitation instability.