Case Report on Rare Presentation of Sigmoid Volvulus with Perforated Appendicitis from Yekatit 12 Hospital Medical College Addis Ababa, Ethiopia

Abstract

Sigmoid volvulus is one of the causes of large-bowel obstruction that is usually common in males, and the management outcome depends on the patient’s clinical condition upon presentation. Open or laparoscopic surgery is the mainstay of management for sigmoid volvulus, except for some conditions where conservative management is given priority, eg, patients unfit for surgery. Rectal deflation is one of the options for conservative management for simple sigmoid volvulus for patients visiting the emergency outpatient department to optimize the patient for semi-elective or elective procedures as management for patients unfit for surgery. In our case, the patient’s clinical condition on his first visit was smooth and he was diagnosed to have simple sigmoid volvulus, for which deflation was tried but failed. The patient was operated on on the third day of failed deflation, and the intraoperative finding was colonic perforation distal to the obstruction associated with perforated appendicitis. Although the colonic perforation was assumed to be due to a secondary rectal tube deflation attempt, the cause of the perforated appendicitis was not clear, ie, whether the appendicitis was primary or secondary, as well as there being no report on perforated appendicitis in common complications of sigmoid volvulus.

Keywords:

• sigmoid volvulus
• appendicitis
• colonic perforation

Acknowledgments

The authors acknowledge everybody who participated in the management of the patient to achieve the best outcome for him, especially the residents. We also extend our deepest gratitude to the college administration for their permission to use the patient’s medical record.

Consent

Institutional approval was not required for the publication of these case details. We obtained documented and witnessed informed verbal consent from the patient to publish this case report.

Disclosure

The authors report no conflicts of interest in this work.