A Twist on Adolescent Abdominal Pain in the Emergency Department

Abdominal pain is a common complaint in pediatric patients in the emergency department (ED). Evolutions in clinical practice have shifted away from computed tomography (CT) to ultrasound (US) in assessing abdominal pain. However, ultrasound may not reliably rule out critical diagnoses. We present a 15-year-old male with intermittent suprapubic abdominal pain. Subsequent CT imaging showed swirling mesenteric vessels with a dilated sigmoid colon. In adolescent abdominal pain, sigmoid volvulus (SV), although rare, should be considered. Clinicians should avoid anchoring bias by maintaining a broad differential. Definitive care is surgical with resection to prevent recurrence.