Sigmoid Volvulus Complicated by Megacolon and Gangrene in a 50-Year-Old Female – Case Report

• Dr. Rushikesh Yadav

  Author

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A 50-year-old female presented with diffuse abdominal pain for 4 days, sudden-onset colicky pain, progressive 
distension, and complete obstipation. She experienced 2--3 episodes of non-bilious, non-projectile vomiting the 
day prior to admission. No history of trauma or prior surgeries was reported. Physical exam revealed distension, 
diffuse tenderness with guarding and rigidity, and absent bowel sounds. Plain abdominal X-ray demonstrated 
multiple air-fluid levels and gross colonic dilatation. Ultrasound suggested an overdistended gallbladder and 
pelvic fluid, with sluggish intestinal peristalsis. Contrast-enhanced CT scan showed massive sigmoid dilatation 
(maximum transverse diameter 7.5 cm) with an abrupt cut-off at the distal rectosigmoid junction and collapse of 
the rectum, raising suspicion for sigmoid volvulus with vascular compromise. A provisional diagnosis of sigmoid 
volvulus with megacolon was made. Emergency exploratory laparotomy revealed sigmoid volvulus with 
mesenteric ischemia and gangrene extending proximally into the upper rectum; the colon was dilated 
approximately 10--12 cm. No perforation was identified. Resection of the gangrenous sigmoid and proximal 
rectum was performed, and a Hartmann's procedure constructed. 
Post-operatively, the patient was managed in ICU with intravenous fluids and broad-spectrum antibiotics. The 
course was uneventful. This case highlights the importance of prompt radiological diagnosis and timely surgical 
intervention in sigmoid volvulus with megacolon and gangrene. 

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