Bradycardia and hypotension are well-recognized clinical presentations in the emergency department, and common causes include cardiac, metabolic, or drug-related factors. However, gastrointestinal pathologies are seldom considered within the initial differential diagnosis. We report the case of a 75-year-old man who presented with light-headedness due to life-threatening bradycardia and hypotension. A chest radiograph incidentally revealed marked colonic distension beneath the diaphragm. After stabilizing his vital signs with vasopressors, a computed tomography revealed a sigmoid volvulus. Emergency colonoscopic decompression led in a rapid stabilization of his vital signs, permitting discontinuation of vasopressor support. This case emphasizes that gastrointestinal disorders, like sigmoid volvulus, should be considered in the initial differential diagnosis of bradycardia and hypotension.
Suenaga et al. (Mon,) studied this question.