60Constipation is very common in children 1,2 . The estimated prevalence of functional constipation in children is 4% to 36% 1,2 . The complaint of constipation accounts for 3% of children visits to primary physicians and 25% of visits to pediatric gastroenterologist 1,2 . In spite of its prevalence, it rarely causes serious complications in children, such as sigmoid colon volvulus 3 . The volvulus of the sigmoid colon is believed to be caused by a twist of the mesentery of the redundant colon 3 . An abdominal radiograph is helpful in diagnosing the presence of sigmoid volvulus. There are a few specific radiographic signs for sigmoid volvulus, including the dilated ahaustral loops. Rectal tube reduction is very successful in reducing sigmoid volvulus; however, ultimately, most patients require sigmoidectomy 4,5 .The aim of this report is to present a rare case of sigmoid volvulus in a young female due to chronic constipation.
THE CASEThe patient was a healthy thirteen-year-old female adolescent, who had a long history of chronic constipation and was occasionally using laxatives. As a newborn, she did not have delayed passage of meconium. She presented to the emergency room with a three-day history of severe abdominal pain, abdominal distension and bilious vomiting. On examination, her abdomen was distended and tender. Rectal examination revealed an empty rectum. The total white blood cell (WBC) count was slightly elevated at 10,000 with 75% polymorphonucleocytes. The abdominal X-ray revealed a severely dilated sigmoid colon suggestive of volvulus. The patient had a contrast enema study, which revealed a cut-off point of obstruction at the sigmoid colon, see figures 1 (A and B). The volvulus was reduced via a rectal tube. Subsequently, she had an elective sigmoidectomy and primary re-anastomosis. The rectal biopsy did not show evidence of Hirschsprung's disease. The patient was discharged in good general condition on the seventh postoperative day.We report a case of one of the rare complications of constipation in an adolescent. The patient presented with acute abdominal symptoms and the radiographic images revealed a dilated twisted sigmoid colon. Rectal tube reduction was successful and subsequently, the patient underwent sigmoidectomy and uneventful recovery.