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Background <p>Sigmoid volvulus is an uncommon cause of bowel obstruction in pediatric and adolescent populations, characterized by the manual twisting of the sigmoid colon around its mesenteric axis, potentially leading to ischemia, necrosis, and perforation if untreated. Dolichocolon, an anatomical variant involving elongation of the colon, is closely associated with chronic constipation and serves as a risk factor for sigmoid volvulus.​</p> Case Presentation <p>A 36-year-old male with intellectual disability presented with 15 days of colicky abdominal pain, progressive distention, and obstipation. History included chronic constipation and a prior conservatively managed episode 6 months earlier. Examination revealed dehydration, tachycardia, respiratory distress, marked abdominal distention with tenderness, and empty rectum. Laboratory findings included hemoglobin 11.2&#xa0;g/dL and hypokalemia (2.4 mmol/L); he required mechanical ventilation, antibiotics, and potassium replacement.</p> <p>After resuscitation, emergency laparotomy revealed non-gangrenous twisted edematous sigmoid on mesenteric pedicle, flaccid atonic colon, and dilated rectum. Manual detorsion preceded subtotal colectomy (220&#xa0;cm) with end ileostomy. Histopathology showed mucosal/muscularis/nerve plexus hypertrophy and mesenteric/submucosal fibrosis. Recovery was uneventful; discharged postoperative day 5, no complications at 1-month follow-up.</p> Discussion <p> Recurrent sigmoid volvulus with dolichocolon and megacolon resists endoscopic decompression due to profound atony and redundancy (recurrence up to 82%). Subtotal colectomy removes dysfunctional colon, achieving near-zero recurrence, supported by histopathology (mucosal/muscular hypertrophy, fibrosis). Prompt CT and surgery prevent ischemia in delayed presentations.</p> Conclusion <p> Subtotal colectomy (220 cm) is definitive for recurrent volvulus with megacolon/dolichocolon, eliminating complications by resecting redundant, atonic bowel.</p>

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Subtotal Colectomy of 220 cm in a Patient with Massive Colonic Dilation and Dolichocolon: A Case Report

  • 期刊论文

  • 发表日期：

    2025年12月6日

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  • Hemant Jain,
  • Shubhanshu Vats,
  • Parikshit Nagda

摘要

Background

Sigmoid volvulus is an uncommon cause of bowel obstruction in pediatric and adolescent populations, characterized by the manual twisting of the sigmoid colon around its mesenteric axis, potentially leading to ischemia, necrosis, and perforation if untreated. Dolichocolon, an anatomical variant involving elongation of the colon, is closely associated with chronic constipation and serves as a risk factor for sigmoid volvulus.​

Case Presentation

A 36-year-old male with intellectual disability presented with 15 days of colicky abdominal pain, progressive distention, and obstipation. History included chronic constipation and a prior conservatively managed episode 6 months earlier. Examination revealed dehydration, tachycardia, respiratory distress, marked abdominal distention with tenderness, and empty rectum. Laboratory findings included hemoglobin 11.2 g/dL and hypokalemia (2.4 mmol/L); he required mechanical ventilation, antibiotics, and potassium replacement.

After resuscitation, emergency laparotomy revealed non-gangrenous twisted edematous sigmoid on mesenteric pedicle, flaccid atonic colon, and dilated rectum. Manual detorsion preceded subtotal colectomy (220 cm) with end ileostomy. Histopathology showed mucosal/muscularis/nerve plexus hypertrophy and mesenteric/submucosal fibrosis. Recovery was uneventful; discharged postoperative day 5, no complications at 1-month follow-up.

Discussion

Recurrent sigmoid volvulus with dolichocolon and megacolon resists endoscopic decompression due to profound atony and redundancy (recurrence up to 82%). Subtotal colectomy removes dysfunctional colon, achieving near-zero recurrence, supported by histopathology (mucosal/muscular hypertrophy, fibrosis). Prompt CT and surgery prevent ischemia in delayed presentations.

Conclusion

Subtotal colectomy (220 cm) is definitive for recurrent volvulus with megacolon/dolichocolon, eliminating complications by resecting redundant, atonic bowel.