Case Report: Organo-axial Sigmoid Volvulus mimicking Sigmoid Colon Malignancy

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Abstract

An 86-year-old man presented with 5 days of constipation and no constitutional symptoms. Despite a history of prior lower abdominal pain and constipation three months earlier, prior imaging and endoscopy revealed no suspicious findings. On admission, abdominal examination showed distension without tenderness, and initial laboratory results were unremarkable. Radiographs demonstrated dilated large bowel loops, while a follow-up CT scan revealed a transition point in the sigmoid colon with gross mural thickening of the sigmoid colon and whirling of the peri-colonic vessels along the long-axis of the sigmoid colon, leading to a diagnosis of organo-axial sigmoid volvulus. The patient’s symptoms resolved spontaneously during admission, and he was discharged after three days of conservative management.

Sigmoid volvulus is the most common colonic volvulus, occurring primarily in immobile, constipated individuals. Organo-axial volvulus, a rarer subtype, involves twisting along the longitudinal axis. Diagnosis is largely radiological, and early intervention is crucial to prevent complications such as bowel ischemia, necrosis, and perforation. While elective surgery is recommended to reduce recurrence and improve outcomes, conservative management may be suitable for frail, high-risk patients. Organo-axial volvulus should be considered in the differential diagnosis of sigmoid colon obstruction, especially when malignancy is suspected.