Perforated Sigmoid Volvulus in an Elderly Male with Expressive Aphasia

We report on a 73-year-old male with expressive aphasia and multiple comorbidities that presented with generalized abdominal pain, nausea, and no bowel movement or flatus in the last 3 days. On physical exam his vital signs were stable and his abdomen was distended, firm, and diffusely tender to palpation with guarding along with hyperactive bowel sounds. Computed Tomography (CT) scan was highly suggestive of a sigmoid volvulus. Colonoscopic decompression was unsuccessful, so surgical repair of the volvulus was indicated. Laparotomy revealed significant distention of the sigmoid and rectosigmoid junctions with a sigmoid volvulus that was impacted with stool up to the ascending colon, and a small serosal tear to the cecum with bowel contents dispersed throughout the abdomen. Rectosigmoid resection with a diverting colostomy and an ileo-ascending colon anastomosis were performed. It is important to recognize the constellation of symptoms for sigmoid volvulus in patients of this population in order to reduce incidence and progressive consequences associated with chronic presentation.