A Lesson to Learn in an Iatrogenic Perforation of Sigmoid Volvulus after Endoscopic Derotation

Abstract

A 78-year-old gentleman was diagnosed with stable sigmoid volvulus after complaining of acute abdominal pain with no bowel opening for a week. Abdominal radiography confirmed the diagnosis after showing a typical coffee bean sign. Opting for conservative management, an urgent endoscopic reduction was attempted with insertion of flatus tube and achieved successfully. However, the flatus tube dislodged in the ward and reinsertion was attempted without direct vision. Patient’s condition deteriorated and computed tomography of the abdomen revealed an extensive pneumoperitoneum requiring urgent laparotomy. Massive faecal contamination was visualized with evidence of a sharp tip of the flatus tube piercing through the sigmoid colonic wall. Hartmann's procedure was performed. However, he deteriorated despite the surgery. He succumbed 3 days after the operation. We describe a case of a successful endoscopic derotation of sigmoid volvulus with iatrogenic bowel perforation after reinsertion of flatus tube.