Barw Barw Medical Journal 2960-1959 2025 12 28 Atypical Sigmoid Volvulus in an Adolescent: A Case Report and Literature Review 63 68 10.58742/bmj.v4i1.219 eng Dana T. Gharib Department of Gastroenterology and Hepatology, Gastroenterology and Hepatology Teaching Hospital, Zanko Street, Sulaymaniyah, Iraq. dana.gharib@gmail.com Dara Ahmed Mohammed College of Medicine, Department of Clinical Sciences, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. dara.mohammed@gmail.com Araz Aziz Abdulla College of Medicine, Department of Clinical Sciences, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. araz.abdulla@gmail.com Othman O. Qadr Department of Radiology, Gardoon Radiology Center, Ibrahim Pasha Street, Sulaymaniyah, Iraq. othman.qadr@gmail.com Karokh F. Hama Hussein Department of Gastroenterology and Hepatology, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. karokh.hussein@gmail.com Deari A. Ismaeil Department of Gastroenterological Surgery, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. deari.ismaeil@univsul.edu.iq Hemn H. Kaka Ali Department of Gastroenterology and Hepatology, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. hemn.ali@gmail.com Dilan Hikmat Department of Internal Medicine, University of Michigan, Sparrow Hospital, Lansing, Michigan, USA. dilansarmadhiwa.hikmat@UMHSparrow.org Hiwa O. Abdullah Department of Scientific Affairs, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. hiewaom96@gmail.com 2025 09 30 Introduction Sigmoid volvulus is an underrecognized diagnosis with potentially fatal outcomes in adolescents; the current study aims to present an adolescent with mild symptoms but was found to have extensive ischemic sigmoid volvulus. Case presentation An 18-year-old male complained of three days of moderate colicky abdominal pain, with decreased appetite and diarrhea. Physical examination revealed diffuse abdominal tenderness and exaggerated bowel sounds without abdominal distension. A contrast-enhanced computed tomography scan demonstrated evidence of twisting the sigmoid and a part of the left colon around each other but without signs of ischemia and perforation. Sigmoidoscopy showed volvulus with dusky ischemic mucosa. An immediate surgical intervention through Hartmann's procedure was performed. After three months of the operation, colostomy closure and colorectal re-anastomosis were performed. Literature review In a review of the literature, adolescents presented with symptoms of abdominal pain, swelling, vomiting, dehydration, and even shock in more severe cases. Despite the lack of data regarding the optimal long-term approach for sigmoid volvulus in adolescents, in a review of 63 cases, 77% of them received operative treatment, with sigmoidectomy being the predominant procedure. The total mortality rate was 6%, with an operative mortality rate of 8.1%. Conclusion Strangulated sigmoid volvulus should be considered in adolescents with abdominal pain despite having diarrhea and no clinically evident abdominal distention. Hartman’s procedure may result in a good outcome.