Sigmoid Volvulus in a Healthy Adolescent Male

We report the case of a 15-year-old previously healthy male who presented with several days of progressive abdominal pain, vomiting, and anorexia. On arrival to the emergency department, he was hemodynamically stable. Patient's abdominal exam revealed a soft, benign abdomen with right-sided greater than left-sided tenderness. Cross-sectional imaging demonstrated sigmoid volvulus without evidence of pneumatosis, perforation, or free air. He underwent multidisciplinary evaluation by pediatric surgery and gastroenterology, and urgent endoscopic detorsion was performed. Pediatric sigmoid volvulus is rare, accounting for a small minority of large bowel obstructions in this age group. Symptoms may be nonspecific, and exam findings can appear reassuring despite the presence of a high-risk surgical emergency. This case highlights the importance of maintaining a broad differential diagnosis in adolescents presenting with abdominal pain and underscores the role of imaging and multidisciplinary collaboration in timely recognition and management.