Partial Sigmoid Volvulus Presenting as Acute Pediatric Bowel Obstruction: A Surgical Case Report

Sigmoid volvulus is a rare cause of large bowel obstruction in the pediatric population and is often associated with chronic constipation and neurodevelopmental disorders. Delayed diagnosis is common due to nonspecific clinical presentation, increasing the risk of complications. We report the case of a 14-year-old male patient with autism spectrum disorder who presented with a five-day history of abdominal pain, vomiting, and constipation. Imaging findings were consistent with sigmoid volvulus. Initial endoscopic detorsion was unsuccessful due to tight torsion and mucosal changes, necessitating emergency exploratory laparotomy. Intraoperatively, a 270° anticlockwise sigmoid volvulus was identified and detorsed. Sigmoidopexy was performed due to lack of consent for resection. The postoperative course was complicated by small bowel obstruction secondary to adhesions and partial small bowel volvulus, requiring re-exploration and adhesiolysis. The patient recovered well following the second procedure. Pediatric sigmoid volvulus is a rare but important surgical emergency requiring a high index of suspicion. While endoscopic reduction can be attempted in stable patients, definitive surgical management should be considered early to prevent recurrence and complications. Sigmoidopexy alone may be associated with increased risk of recurrence and postoperative complications, highlighting the importance of counseling for definitive resection.