Abdominal pain in an elderly with a twist: a case of colonic volvulus

Abdominal pain in the elderly patient is a common symptom and reason to resort to the emergency service. Geriatric ill patients present unique challenges in the anamnesis, physical examination and to determine expectations for rehabilitation and meaningful recovery. We present the case of an 80-year-old man, dependent on activities of daily living due to dementia. He was admitted to the emergency department with a clinic of abdominal pain and constipation. Abdominal radiography revealed dilatation of the sigmoid colon (coffee bean sign), as did abdominal CT, suggesting the diagnosis of intestinal volvulus. He underwent decompression colonoscopy with resolution. There was no evidence of neoplasia on abdominal CT or endoscopic study, or of another obstructive cause. Sigmoid volvulus is common in men over 70 years, with neuropsychiatric pathology and as a risk factor the patient had immobility and a long and redundant colon described in the endoscopic examination. This is a pathology with high mortality and risk of recurrence to be recognised in institutionalized elderly people.