Recently, we treated a 46-year-old male with a history of Down syndrome and severe mental retardation who came to the emergency department of our hospital with diffuse abdominal pain and progressive abdominal pain of 24 hours.
She had a history of constipation and no bowel movements in the past 2 days.
As a history of interest, the patient had presented, 13 years before, a gastric volvulus that was operated on urgently, performing a surgical gastropexy.
During surgery, a dolicocolon was evidenced, with absence of fixation ligaments, but no procedure was performed.
In the current physical examination, only abdominal disorientation and tympanism accompanied by diffuse abdominal pain stood out.
Rectal examination showed no evidence of feces in rectal ampulla.
Blood count and biochemistry were normal.
A simple abdominal X-ray showed a massive dilation of the proximal colon.
Computerized tomography (CT) scans could also detect this malformation.
The barium enema performed later demonstrated the typical "bird peak" image.
Although with difficulty, the barium moved towards the dilated segment of the splenic angle.
A therapeutic approach was implemented, with which the colonic segment was developed.
The patient eliminated a large amount of feces and gases, asymptomatic at 24-48 hours, so he was discharged from hospital, being the surgery service.
Two days later, the symptoms reappeared and he was diagnosed with recurrence of volvulus of splenic flexure of the colon.
Discharge was repeated, resolving the urgent process.
The patient underwent elective surgery, with resection of the redundant segment of the colon.
The postoperative course was uneventful.
