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Case Report
Spontaneous detorsion of sigmoid volvulus in a toddler: A timely abdominal X-ray that clinched the diagnosis and a review of the role of radiology
1 Associate professor, Radiology Department, University of Calabar, Cross River State, Nigeria
2 Senior lecturer, Surgery Department, University of Calabar, Cross River State, Nigeria
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Akintunde Olusijibomi Akintomide
Radiology Department, University of Calabar Teaching Hospital, Calabar, Cross River State,
Nigeria
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Article ID: 101006Z01AA2019
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Akintomide AO, Inyang AW. Spontaneous detorsion of sigmoid volvulus in a toddler: A timely abdominal X-ray that clinched the diagnosis and a review of the role of radiology. Int J Case Rep Images 2019;10:101006Z01AA2019.ABSTRACT
Introduction: Sigmoid volvulus is extremely rare in children and the spontaneous detorsion is even more rarely encountered by clinicians. If it is undiagnosed on first presentation because of spontaneous detorsion, it could recur with severe complications like bowel wall gangrene, perforation and peritonitis which requires emergency Laparotomy with attendant higher mortality.
Case Report: An acutely ill looking eighteen months toddler presented with a two day history of sudden onset of abdominal distension without associated pain. There were no obvious risk factors or previous history of similar episode. The abnormal findings on physical examination were mild pallor, abdominal distension and reduced bowel sounds. All his vital signs were stable. The urgent abdominal X-ray carried out soon after presentation, revealed the classical “Coffee bean sign” of the displaced dilated sigmoid colon. He was admitted, placed on intravenous fluid and nil per oral, and booked for Laparotomy. In about five to six hours while waiting for the surgery, his bowel opened to flatus and later to faeces with subsequent reduction in abdominal girth and normalized bowel sounds.
Conclusion: Sigmoid Volvulus occurs in children and spontaneous untwisting is a reality. If the abdominal X-ray was done after the passage of flatus, the diagnosis would have been missed. We recommend that patients should have an abdominal X-ray immediately they present with sudden onset of abdominal distension to increase the chances of demonstrating the radiological features of sigmoid volvulus in order to offer an elective surgery to prevent recurrence, complications and reduce mortality.
Keywords: Detorsion, Sigmoid volvulus, Timely abdominal X-ray, Toddler
SUPPORTING INFORMATION
Author Contributions
Akintunde Olusijibomi Akintomide - Substantial contributions to conception and design, Acquisition of data, Drafting the article, Final approval of the version to be published
Akan Wilson Inyang - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this case report.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2019 Akintunde Olusijibomi Akintomide et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
