Sigmoid volvulus in a child

A 10-year-old boy who was previously well presented with sudden onset of intermittent severe abdominal pain, non-bilious vomiting and constipation. Abdominal examination was essentially normal. Abdominal radiographs showed a large dilated loop of the colon with a few air-fluid levels on erect views (A) and supine views displayed a coffee-bean sign (B). Contrast enema was done to exclude other pathologies, which disclosed gradual narrowing of the sigmoid colon up to the level of obstruction, this is termed bird´s beak sign (C). Radiological features were consistent with diagnosis of sigmoid volvulus (SV). The patient was taken to theatre for sigmoidoscopy, which successfully de-rotated SV and elective date for surgery was prearranged. However, the patient presented with recurrence of symptoms 3 weeks later. Urgent laparotomy was performed and 360-degree rotation of sigmoid colon identified (D). The bowel was de-rotated and sigmoid resection with primary anastomosis was performed. There were no complications and the child was asymptomatic at one month follow-up. Histology result of resected sigmoid colon was within normal limits.