The Longest Colonic Resection Ever: A case report on Subtotal Colectomy of 220 cm in a mentally retardedPatient with Massive Colonic Dilation and Dolichocolon

Background: Sigmoid volvulus is an uncommon cause of bowel obstruction in pediatric and adolescent populations, characterized by the twisting of the sigmoid colon around its mesenteric axis, potentially leading to ischemia, necrosis, and perforation if untreated. Dolichocolon, an anatomical variant involving elongation of the colon, is closely associated with chronic constipation and serves as a risk factor for sigmoid volvulus.​ Case Presentation: We report the case of a 36-year-old mentally retarded male who presented with a 15-day history of colicky abdominal pain, progressive distention, and inability to pass stool or flatus. The patient's history revealed chronic constipation and a similar episode six months prior, managed conservatively. Clinical examination indicated dehydration, tachycardia, and respiratory distress. Abdominal assessment showed significant distention and tenderness, with an empty rectum on digital examination. Laboratory findings included hemoglobin of 11.2 g/dL and hypokalemia (2.4 mmol/L) patient kept on mechanical ventilator, initially managed by antibiotics and potassium chloride. Radiological investigations revealed dilated bowel loops suggestive of mechanical obstruction, with CT imaging confirming sigmoid volvulus and gross proximal colon dilatation up to 10.8 cm. Following resuscitation and antibiotic administration, an emergency laparotomy was performed, revealing a dilated, edematous sigmoid colon twisted on its mesenteric pedicle, along with a flaccid, atonic colon and dilated rectum. Exploratory laparotomy (manual untwisting) was followed by sub-total colectomy with end ileostomy. Histopathological analysis demonstrated hypertrophy of the mucosa, muscularis propria, nerve plexuses, and fibrosis in the mesentery and submucosa. The patient had an uneventful recovery and was discharged on the fifth postoperative day, with no complications reported at the one-month follow-up.​