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

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