Introduction and importance: There is currently no comprehensive understanding of the clinical presentation, radiological features, and optimal management strategies for splenic flexure volvulus (SFV). In this case report, we present a 57-year-old man diagnosed with SFV who was successfully managed at a tertiary care hospital in Iran. Case presentation: A 57-year-old man presented with a 2-day history of progressive abdominal distension, vomiting, severe pain, and absence of bowel movements. On admission, he was tachycardic and hypoxic. Contrast-enhanced CT demonstrated diffuse colonic dilatation with an abrupt transition at the proximal descending colon. Exploratory laparotomy confirmed SFV. The patient underwent subtotal colectomy with distal stump closure and end ileostomy. Clinical discussion: This case demonstrates how SFV can present with nonspecific symptoms and inconclusive imaging, yet still require prompt surgical recognition and intervention. Although imaging studies were suggestive of a large-bowel obstruction, SFV was not initially suspected. Early laparotomy allowed definitive diagnosis and treatment, resulting in a good outcome. Conclusions: Because imaging findings can sometimes be inconclusive in diagnosing SFV, a high index of clinical suspicion is essential for timely diagnosis and to prevent delays in treatment. Careful attention to subtle clinical clues − such as a history of congenital anomalies or prior abdominal surgeries − may aid in early recognition and appropriate management of this rare condition.
Rezaei et al. (2026) studied this question.