Emergency Surgical Management and Enhanced Recovery of Complicated Sigmoid Volvulus in an Octogenarian: A Case Report and Literature Review

Abstract

Sigmoid volvulus (SV) is a potentially deadly surgical emergency, defined as the axial torsion of the sigmoid colon around its mesenteric root. It predominantly occurs in the extreme elderly and frail population and is typically diagnosed as a rapidly progressive closed-loop bowel obstruction. In octogenarians, the challenge in controlling this patient condition is weighing the urgent necessity for mechanical decompression versus the intense perioperative morbidities of emergency laparotomy. In addition, incorporating Enhanced Recovery After Surgery (ERAS) protocols into emergency, contaminated colorectal procedures is an ongoing area of exploration with potential for minimizing hospital time. A female (age 80 years) with a five-day history of progressive mechanical bowel obstruction, exacerbated by an outpatient misdiagnosis, treated iatrogenically with prokinetics and stimulant laxatives. Imaging revealed a massive SV with a distinctive "coffee bean" characteristic. Emergency laparotomy showed a twisted 1080-degree dilated sigmoid colon—successful performance of a Hartmann's procedure (HP). Postoperative care was provided using a modified ERAS regimen, enabling extremely rapid mobilization, immediate enteral feeding, and early discharge on postoperative day 3. Emergency HP provides a safe, definitive solution in geriatric patients with severe multi-turn torsion and physiological vulnerability. This patient demonstrated a great postoperative recovery and underscores the viability and clinical benefit of applying the principles of ERAS to emergency geriatric colorectal surgery.