Case Report: Rapid altitude transition as an environmental trigger for acute sigmoid volvulus following oxaliplatin-based chemotherapy

The article describes a case of a 33-year-old man with hepatocellular carcinoma who underwent oxaliplatin-based chemotherapy at sea level in Xiamen. Less than 48 hours before symptom onset, CT imaging showed no signs of obstruction. During flights to Lhasa (altitude 3,650 m), the patient remained asymptomatic, but within 2 hours of arrival developed acute sigmoid volvulus with full-thickness gangrene. The patient experienced severe abdominal cramping, marked distension, complete constipation, and intense tenesmus. CT imaging confirmed acute volvulus with the classic "coffee-bean sign." The authors suggest that the combination of rapid altitude transition, recent chemotherapy, and colonic redundancy may have precipitated this catastrophic mechanical gastrointestinal emergency.