Sigmoid volvulus after laparoscopic cholecystectomy. An unusual complication

Laparoscopic cholecystectomy has become the standard surgical technique for treating symptomatic gallbladder disease. Intestinal obstruction after laparoscopic cholecystectomy is unusual. We present the case of a 37-year-old man who underwent routine laparoscopic cholecystectomy for cholelithiasis using an American four-port technique. He was well 24 h postoperatively and was discharged. He presented 36 h later with clinical features of bowel obstruction. A sigmoid loop was seen on a plain abdominal radiograph. Laparotomy revealed distension of the large and small bowel to the level of the rectosigmoid junction and a sigmoid volvulus. This was reduced by releasing adhesions to lengthen the sigmoid mesentery. A primary sigmoid resection and anastomosis was not attempted due to luminal discrepancy and lack of bowel preparation. The patient underwent interval sigmoid colectomy 2 weeks later. A sigmoid volvulus following laparoscopic cholecystectomy has not been previously reported. It may be related to the induction of the pneumoperitoneum, combined with the lateral tilt of the table and a long redundant sigmoid colon. This case expands the range of potential complications associated with laparoscopic cholecystectomy and illustrates the need for continued vigilance after apparently routine procedures.