Primary Splenic Flexure Volvulus in a Young Adult With Cerebral Palsy: A Diagnostic and Management Dilemma.

Colonic volvulus is an uncommon cause of intestinal obstruction. Among its subtypes, splenic flexure volvulus (SFV) is exceptionally rare, with only sporadic cases reported. It is most often associated with prior abdominal surgery or laxity of anatomical attachments. We describe a diagnostically challenging case of a 21-year-old man with spastic cerebral palsy and no history of abdominal surgery who presented with classical features of large bowel obstruction. CT imaging revealed a whirlpool sign at the splenic flexure, suggestive of volvulus. However, an emergency colonoscopy showed no evidence of torsion or mucosal ischemia. Because the patient was a poor surgical candidate, he was managed conservatively. Remarkably, his symptoms resolved, and he was discharged on day five of admission. Although rare, SFV should be considered in the differential diagnosis of acute abdomen, particularly in patients with neurodevelopmental disorders. Diagnostic uncertainty and delays in management may compromise patient outcomes. This case highlights a rare instance of spontaneous detorsion, underscoring the challenges of diagnosis, monitoring, and decision-making in a high-risk, noncommunicative patient, while also providing insights into radiographic findings, natural disease course, and recurrence risk.