Sigmoid Volvulus in 24-Year-Olds: Incidence and Clinical Context
Sigmoid volvulus is exceedingly rare in healthy 24-year-old adults, as this condition predominantly affects elderly males over age 70 in Western countries, with a mean age of 56-77 years at presentation. 1
Age-Specific Epidemiology
- In Western countries, sigmoid volvulus preferentially affects elderly males (age >70), making it highly unusual in a 24-year-old patient. 1
- The mean age at presentation ranges from 56 to 77 years across multiple studies, and nearly one-third of all colonic emergencies in elderly patients are due to sigmoid volvulus. 1
- In pediatric and young adult populations, sigmoid volvulus remains a rare occurrence with only isolated case reports documented. 2
- When sigmoid volvulus does occur in younger patients (including teenagers and young adults), it is typically associated with secondary causes rather than the sporadic form seen in elderly patients. 3
Geographic and Demographic Variations
- In endemic areas (the "volvulus belt" including Africa, South America, Russia, Eastern Europe, the Middle East, India, and Brazil), colonic volvulus represents 13-42% of all intestinal obstructions, but age distribution data specific to 24-year-olds is not well-documented. 1
- Endemic sigmoid volvulus is considered a different clinical entity than sporadic volvulus, with anatomical differences (longer sigmoid colon, narrower mesenteric base) more common in African populations. 1
- The median age in children at presentation is 7 years (ranging from 4 hours to 18 years), suggesting that cases in the early 20s fall into an unusual transitional zone. 2
Secondary Causes in Young Adults
When sigmoid volvulus occurs in younger patients like a 24-year-old, clinicians must actively search for underlying predisposing conditions: 1
- Hirschsprung's disease or Chagas disease causing megacolon 1
- Congenital megacolon (the most important secondary cause in young people) 3
- Anatomical predisposition with dolicho-sigmoid (elongated sigmoid colon on a narrow mesenteric base) 1
- Chronic constipation with frequent laxative use 1
- High-fiber diet combined with anatomical factors 1
Clinical Implications for a 24-Year-Old
- If a healthy 24-year-old presents with the classic triad of abdominal pain, constipation, and abdominal distension, sigmoid volvulus should be included in the differential diagnosis but is not the most likely etiology. 2, 4
- Case reports document sigmoid volvulus in a 19-year-old male and a 33-year-old woman, confirming it can occur but emphasizing its rarity in this age group. 2, 4
- The diagnosis requires high clinical suspicion, as it can be misdiagnosed as fecal impaction or other more common conditions in young adults. 4
Diagnostic Approach When Suspected
- Plain abdominal radiographs showing the "coffee bean sign" are first-line imaging. 1, 5
- Abdominal CT is the gold standard, revealing dilated colon with air/fluid level and the "whirl sign" representing twisted colon and mesentery. 1, 5
- Digital rectal examination typically reveals an empty rectum, which is characteristic. 5
Critical Caveat
The absence of typical risk factors (elderly age, institutionalization, neuropsychiatric medications, chronic constipation) in a healthy 24-year-old makes sigmoid volvulus highly unlikely, and alternative diagnoses should be thoroughly investigated before concluding this is the cause of symptoms. 1