Discussion
Etiology of sigmoid volvulus is a redundant loop of sigmoid that twists
on its mesenteric pedicle more than 1800 which lead to
obstruction and venous outflow and arterial inflow disturbance,
respectively. Prolongation of this disturbance leads to mucosal ischemia
and infraction, and eventually, transmural perforation (4).
There are some known risk factors that have been associated with sigmoid
volvulus such as anatomical redundancies in the mesentery, malfixation
of the mesentery, chronic constipation, sedentary lifestyle, and
neurological disease (5)
Plain abdominal radiographs will show the classical coffee bean or
kidney bean sign, and often dilatation of the proximal colon. The
characteristic ”whirl’ sign on CT scan corresponds with twisted
mesentery (6).
When the viability of the sigmoid colon mucosa is suspected, flexible
sigmoidoscopy is indicated to examine the colon mucosa, as well as
insufflationduring sigmoidoscopy to untwist the volvulus (7). Those
patients with failed decompression or those with complications such as
mucosal infarction or more advanced sequels need surgical intervention.
The surgery of choice is a sigmoid colectomy. Performing primary
anastomosis versus a Hartman procedure depends on intraoperative
findings and patients status .
In the reported articles, there are few intestinal complications
associated with cryptorchidism. Most of these articles considered the
mechanical obstruction caused by the adhesion of the undescended testis
or the compressive effect of the gubernaculum as the main cause of the
mechanical obstruction of the small intestine.
Nik Hamidi et al reported A 22-year-old man with typical symptoms and
imaging findings reported a small bowel obstruction that was caused by
adhesions from an undescended testis (8). Kim et al and Bassiouny et al
reported such cases of small bowel obstruction due to twisting of small
bowel around gubernaculum of an undescendent testis (9),(10)
Despite the existence of reports of small bowel mechanical obstruction
due to undescended testis, no report of colonic volvulus was found in
the literature, and to our knowledge, this is the first report of such a
case.
Sigmoid volvulus is one of the common cases that surgeons frequently
encounter. The case scenarios are often the same, and from experience,
most cases result from a long meso and an elongated sigmoid secondary to
prolonged constipation. Therefore, it is clear that a scrotal
examination would not be part of the routine examination of a patient
with sigmoid volvulus. In this article, by reporting a very rare
etiology for a very common pathology, we tried to point out the
importance of head to toe examination in all patients.