Federico  Marchesi,Filippo  Montali,Gerardo  Palmieri,Renato Costi,
Triple Trouble: Colonic Obstruction by Sigmoid Volvulus in a Patient Affected by Ogilvie Syndrome and Giant Bochdalek Hernia
Surgical Case Reports
2020
2613-5965
http://dx.doi.org/10.31487/j.SCR.2020.05.12
https://www.sciencerepository.org/triple-trouble-colonic-obstruction-by-sigmoid-volvulus-in-a-patient_SCR-2020-5-112 
Abstract: Bochdalek hernia is a congenital left diaphragmatic hernia (CDH), usually diagnosed in children following
the onset of thoracic symptoms such as dyspnea or tachycardia. Ogilvie’s syndrome (or acute colonic
pseudo-obstruction) may be due to several conditions, including neurologic diseases, neuroleptic therapy
and systemic syndromes, and is characterized by massive colon dilation in the absence of mechanical
obstruction or toxic mega-colon. Sigmoid volvulus, consisting of sigmoid rotation around its axis, is a
relatively frequent cause of large bowel obstruction. The three simultaneous conditions in the same patient
in an emergency setting are rare, leading to a challenging situation concerning diagnosis and management.
Here, we report the case of a mentally disabled 59-year-old female presenting with colonic obstruction
caused by sigmoid volvulus after several episodes of Ogilvie’s syndrome-related pseudo-occlusion, found
to have a giant left-sided Bochdalek diaphragmatic hernia. The patient was treated by an emergency
laparoscopic approach. Despite the resolution of the abdominal picture, the patient died on postoperative
day 15 by respiratory failure.Keywords: Colonic obstruction, sigmoid volvulus, Ogilvie syndrome, Bochdalek hernia