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.