FIGURE 116.12 Sigmoid volvulus Abdominal radiograph shows a markedly distended sigmoid colon (arrows ) (Reprinted with permission from Lee E Pediatric Radiology: Practical Imaging Evaluation of Infants and Children Philadelphia, PA: Wolters Kluwer; 2017.) Sigmoid Volvulus Children with a history of severe chronic constipation or colonic dysmotility are at risk of developing sigmoid volvulus due to dilatation of the sigmoid colon Symptoms may be insidious in onset but often progress to signs and symptoms of complete bowel obstruction Children with a history of colonic dysmotility who present with acute severe abdominal pain, especially if vomiting or distension are present, should have abdominal radiographs obtained in order to evaluate for possible sigmoid volvulus ( Fig 116.12 )