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There is limited epidemiologic data on sigmoid volvulus (SV) from non-endemic regions. Therefore, we performed a multicenter study to report contemporary outcomes and appraise literature-based methods that pair diagnostic and procedural codes to identify SV. Using an automated search for patients with ‘volvulus’ in our system from 2011 to 2021, we reviewed electronic charts to clarify the diagnosis, automatically replicate three strategies to identify SV, and retrieved 6-month outcomes. Of 895 patients, 109 had SV. Literature-based strategies poorly identified SV. At the index admission, patients underwent endoscopic reduction alone (33%), emergent (16.5%), semi-elective (34%), or elective (16.5%) surgery. Endoscopic reduction alone had high recurrence rates and delayed surgery was associated with worse outcomes. Literature-based strategies to identify SV suffer from misclassification bias which affects patient counseling. In this large series, one-third of patients do not undergo during their index admission despite improved outcomes with earlier surgery. •NSQIP strategies to identify sigmoid volvulus suffer from misclassification bias.•Non-operative and palliative care are common management strategies.•Earlier surgery during the index admission is associated with improved outcomes.•Recurrence rates for sigmoid volvulus are high within the first 6-months.

Pediatric digestive volvulus is a serious condition that carries with it a high rate of morbidity and mortality. This review highlights the pearls and pitfalls of pediatric digestive volvulus, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence. Pediatric digestive volvulus is a deadly condition most commonly associated with malrotation. It occurs when the stomach or small intestine twists on itself, resulting in ischemia and potentially strangulation with necrosis and perforation. Presentation differs based on the gastrointestinal (GI) segment affected, degree of twisting, and acuity of the volvulus. Gastric volvulus most commonly presents with retching with or without nonbilious emesis and epigastric distension with pain, while midgut volvulus typically presents with bilious emesis in infants. Patients with GI necrosis and perforation may present with hemodynamic compromise and peritonitis. If suspected, emergent consultation with the pediatric surgery specialist is necessary, and if this is not available, transfer to a center with a pediatric surgeon is recommended. Imaging includes plain radiography, ultrasound, or upper GI series, while treatment includes resuscitation, administration of antibiotics, and emergent surgical decompression and detorsion of the involved segments. An understanding of pediatric digestive volvulus and its many potential mimics can assist emergency clinicians in diagnosing and managing this deadly disease.

Sigmoid volvulus is a common surgical emergency, especially in elderly patients. Patients can present with a wide range of clinical states: from asymptomatic, to frank peritonitis secondary to colonic perforation. These patients generally need urgent treatment, be it endoscopic decompression of the colon or an upfront colectomy. The World Society of Emergency Surgery united a worldwide group of international experts to review the current evidence and propose a consensus guidelines on the management of sigmoid volvulus.

Purpose Colonic volvulus (CV) is a twist of part of the colon over its mesentery. Although CV is rare in children, its incidence is unknown. Hirschsprung’s disease (HD) represents a significant risk factor of CV in children, especially when diagnosed late. Aim To review the clinical, radiological and management data of children with CV associated with HD. Methods Medical records were reviewed from January 2000 to December 2022 looking for children had CV associated with HD. Results 21 cases (17 males and 4 females) were admitted with CV. Their ages ranged from 8 days to 14 years. Sigmoid volvulus was recorded in 17 (81%) cases, while 4 (19%) cases had cecal volvulus. CV was associated with HD in 9 (42.9%) cases. Their median age was 7 years. Eight cases had sigmoid volvulus associated with short segment HD, while one case had cecal volvulus with long segment HD. CV was the first presentation, before the diagnosis of HD, in 8 cases. The diagnosis of HD was overlooked in 3 cases; 2 cases had an anastomotic leakage after sigmoidectomy, while the third case had recurrence of volvulus after successful nonoperative management. Conclusion The diagnosis of CV in children mandates a high index of suspicion. Moreover, HD should be suspected and excluded in every case of CV in children.

Spleno-sigmoid knotting is the twisting of the spleen around the sigmoid colon, causing obstruction of the sigmoid colon. It is an uncommon cause of intestinal obstruction. To our knowledge, there has been no previous case report of spleno-sigmoid knotting before our case. Here, we present the case of an 18-year-old female patient who visited the surgical emergency outpatient department with diffuse and progressive abdominal pain lasting for one and a half days. She also experienced obstipation and frequent episodes of vomiting of ingested matter. Upon initial evaluation, she exhibited tachycardia and tachypnea, and her abdomen was grossly distended with diffuse direct and rebound tenderness. Further investigation revealed significant leukocytosis with neutrophil predominance. Emergency laparotomy was performed with a possible diagnosis of generalized peritonitis secondary to gangrenous sigmoid volvulus, which revealed gangrenous spleno-sigmoid knotting. Various types of intestinal knots have been reported, with ileo-sigmoid knots being the most common and ileo-ileal knots being the rarest. Wandering spleen is a rare congenital anomaly with a variable clinical presentation ranging from asymptomatic to mild abdominal pain or acute abdomen due to torsion or acute pancreatitis. It can also cause intestinal obstruction, which may be the initial presentation. In patients presenting with acute abdominal pain and features of bowel obstruction, the possibility of spleno-sigmoid knotting should be considered, and early intervention should be instituted to prevent gangrenous progression and sepsis.

Small bowel volvulus is a rare entity in Western adults. Greater insight into epidemiology and outcomes may be gained from a national database inquiry. The Nationwide Inpatient Sample (1998 to 2010), a 20% stratified sample of United States hospitals, was retrospectively reviewed for small bowel volvulus cases (International Classification of Diseases, 9th Edition [ICD-9] code 560.2 excluding gastric/colonic procedures) in patients greater than or equal to 18 years old. There were 2,065,599 hospitalizations for bowel obstruction (ICD-9 560.x). Of those, there were 20,680 (1.00%) small bowel volvulus cases; 169 were attributable to intestinal malrotation. Most cases presented emergently (89.24%) and operative management was employed more frequently than nonoperative (65.21% vs 34.79%, P < .0001). Predictors of mortality included age greater than 50 years, Charlson comorbidity index greater than or equal to 1, emergent admission, peritonitis, acute vascular insufficiency, coagulopathy, and nonoperative management (P < .0001). As the first population-based epidemiological study of small bowel volvulus, our findings provide a robust representation of this rare cause of small bowel obstruction in American adults. •First population-based epidemiological study of SBV in the United States.•SBV accounted for 1% of all bowel obstruction in adults.•Only .82% of SBV were attributable to congenital intestinal malrotation.•Many patients presented emergently with symptoms and signs of an acute abdomen.•Operative management should be used for medically fit patients with volvuli.

Small bowel volvulus is a rare disease, which is also challenging to diagnose. The aims of this study were to characterize the clinical and radiological features associated with small bowel volvulus and treatment and to identify risk factors for associated small bowel necrosis. Patients with small bowel volvulus who underwent operations from January 2001 to December 2015 at the First Affiliated Hospital of China Medical University (Shenyang, China) were reviewed. Clinical, surgical and postsurgical data were registered and analyzed. Thirty-one patients were included for analysis. Fifteen patients were female (48.4%), with an average age of 47.7 years (18-79 years). The clinical signs and symptoms were unspecific and resembled intestinal obstruction. Clinical examination revealed abdominal distension and/or diffuse tenderness with or without signs of peritonitis. The use of CT scans, X-rays or ultrasound did not differ significantly between patients. In 9 of 20 patients that received abdominal CT scans, \"whirlpool sign\" on the CT scan was present. Secondary small bowel volvulus was present in 58.1% of patients, and causes included bands (3), adhesion (7), congenital anomalies (7) and stromal tumor (1). Out of the 31 patients, 15 with gangrenous small bowel had to undergo intestinal resection. Intestinal gangrene was present with higher neutrophils count (p<0.0001) and the presence of bloody ascites (p = 0.004). Three patients died of septic shock (9.68%), and the recurrence rate was 3.23%. To complete an early and accurate diagnosis, a CT scan plus physical exam seems to be the best plan. After diagnosis, an urgent laparotomy must be performed to avoid intestinal necrosis and perforation. After surgery, more than 90% of the patients can expect to have a favorable prognosis.

Gallbladder agenesia is a rare congenital anomaly that is frequently overlooked in clinical practice, often misdiagnosed as chronic sclero-fibrous cholecystitis or cholelithiasis. Failure to recognize it intraoperatively can prompt unnecessary and hazardous exploration of the biliary tree and liver, increasing the risk of iatrogenic injuries. This report describes a rare case of gallbladder agenesia coincidentally discovered during surgery, alongside adult midgut malrotation—both diagnosed intraoperatively. The patient presented with symptoms mimicking biliary colic, which, in 23–55% of gallbladder agenesia cases, lead to symptomatic presentation. Preoperative ultrasound commonly misinterprets the absent gallbladder as a shrunken, hypoplastic, or contracted organ due to artifacts from intestinal gas or adjacent structures. In the presented case, symptoms and ultrasound misinterpretation were likely attributable to the malrotated jejunum positioned beneath the liver. Magnetic resonance imaging (MRI), particularly MR cholangiography, is recommended when ultrasound findings are inconclusive or suggest a scleroatrophic gallbladder, though misinterpretation remains possible due to the condition’s rarity and low clinical awareness. Intraoperatively, overzealous dissection poses the greatest risk. Authors advocate aborting the procedure upon suspicion of agenesia, followed by postoperative confirmatory imaging (CT or MRI), rather than extensive exploration. Adult midgut malrotation is also uncommon, with only 10% diagnosed in adulthood. Most cases are asymptomatic or cause vague abdominal symptoms (pain, nausea, bilious vomiting), often mistaken for biliary pathology. The patient exhibited duodenal nonrotation with right jejunal positioning and normal colon (DNJRCR type). In asymptomatic incidental findings, a conservative approach is recommended. In summary, heightened suspicion for gallbladder agenesia is essential in ambiguous ultrasound reports. Preoperative MRI can prevent unnecessary surgery, while intraoperative recognition should prompt procedure termination and postoperative imaging to avoid iatrogenic complications.

Introduction Sigmoid volvulus is a rare cause of bowel obstruction in young adults and is classically seen in elderly males. In woman of reproductive age, sigmoid volvulus is easily misdiagnosed as a gynecologic emergency, which will contribute to delayed recognition and increased morbidity. Reports of sigmoid volvulus in healthy young females without predisposing factors remain extremely limited in literature. Against this backdrop of established knowledge, we present a unique case that challenges the typical demographic profile of sigmoid volvulus. Case presentation We report a case of a 25-year-old previously healthy Ethiopian woman who presented with progressive abdominal distension, colicky pain, and obstipation. No predisposing anatomic or systemic factors were identified. Despite the absence of advanced imaging modalities such as computed tomography or endoscopy, a clinical suspicion of sigmoid volvulus was raised on the basis of examination findings and the plane abdominal radiography demonstrating the classic “coffee bean” sign. She underwent successful rigid sigmoidoscopic decompression with no complications and remains recurrence free on follow-up. Conclusion This case highlights the importance of maintaining a high index of suspicion for sigmoid volvulus in young women presenting with abdominal complaints, even in the absence of typical risk factors. It also illustrates that accurate diagnosis and effective treatment are achieved using basic clinical tools in resource-limited settings, which emphasizes on the role of clinical acumen and basic radiographic tools in resource-limited settings. Clinicians must be aware of this rare but important differential to avoid misattribution to gynecologic conditions and ensure timely intervention.