Acute Sigmoid Volvulus With Abdominal Compartment Syndrome: A CT Case

A 52-year-old man presents with two weeks of progressively worsening abdominal pain and constipation and arrives hypotensive with severe metabolic acidosis (pH 7.06, lactate 14) and renal impairment (eGFR 26). Imaging and examination indicate acute sigmoid volvulus with extensive bowel dilatation causing abdominal compartment syndrome.

The dilated bowel loops compress the abdominal aorta and pelvic vessels but remain patent distally; the celiac trunk is narrowed likely from median arcuate ligament compression, while the SMA and IMA are patent. The clinical picture includes bowel ischemia potential from impaired mesenteric perfusion and risk of perforation and peritonitis.

Urgent surgical review is recommended. Definitive management in this case involved emergent surgical intervention.

Intraoperatively, a twisted sigmoid with extended devascularized bowel and contamination was found, necessitating a Hartmann procedure. Postoperative course included rapid restoration of renal function and resolution of vasopressor requirements after stabilization and resection.

Sigmoid volvulus can recur if not resected, and detorsion alone carries high recurrence risk. Abdominal compartment syndrome results from increased intra-abdominal pressure affecting cardiac, pulmonary, renal, and gastrointestinal systems; management prioritizes decompression, hemodynamic support, and reducing intra-abdominal volume.