Case presentation
A 67-year-old man, came to the emergency department with a complaint of
abdominal pain and obstipation from 2 days ago. In the post medical
history, he was a healthy man with 3 childs, with no comorbidities, or
history of hospitalization in the past, and he mentioned a history of
constipation. On examination, vital signs were within normal
limits(BP=100/80 mmhg,PR=84 per/min,RR=14 per/min ,T=37),and in
abdominal examination there was mild abdominal distention and mild
general tenderness .With the suspicion of intestinal obstruction, plain
abdominal x-rays were requested, and according to the appearance of
coffee beans in the X-ray (Figure 1), the diagnosis of sigmoid volvulus
was made. In the requested tests Hb was 14.5 g/dl, WBC was 9000 with
70% PMN. The rest of the tests were within normal limits.
After fluid resuscitation, and insertion of a nasogastric tube for upper
decompression, rigid rectosigmoidoscopy was performed in the operating
room, which was unsuccessful. the patient was transferred to the
operating room for laparatomy. After induction of general anesthesia and
midline laparotomy, the sigmoid was clearly warped around the
meso-sigmoid. After manual untwisting, we noticed a tubular structure at
the base of the meso-sigmoid(Figure 2 and 3). Suspecting that the said
element is the spermatic cord, the scrotum was touched and it was found
that the left scrotum was empty. With further exploration and release of
adhesions between the spermatic cord and meso-sigmoid, the testis was
observed with a normal and non-atrophic appearance. After releasing all
adhesions, orchidectomy was performed intra-abdominally by urologist.
Then sigmoidectomy was performed by Hartmann’s method by attending
surgeon. On the first day after the operation, the number of leukocytes
decreased (12000/dl) and the general condition of the patient improved.
patient passed the post-operative period without significant incident
and was discharged after 4 days. In the pathology report of the testicle
sample, no neoplasia or dysplasia was reported.