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.