Splenic flexure volvulus, a rare etiology of colonic obstruction: Case report

Abstract

Introduction Splenic flexure volvulus (SFV) occurs as a result of twisting or torsion of a redundant colon around its mesentery. The SFV can be divided into primary and secondary types. Presentation of case An 82-year-old woman with a previous history of Parkinson's disease, diabetes mellitus and hypertension presented with a primary complaimt of obstipation and progressive abdominal pain. Abdomen was grossly distended and tympanic with generalized tenderness. The rectum was empty on digital rectal examination. Complete blood count showed leuckocytosis and neutrophlia. Plain abdominal X-rays showed distented cecum and ascending colon without any air in the gut distal to the splenic flexure. Regarding her unstable condition even aftre fluid resuscitation, she was transferred to the operating room. SFV was found and the standard left hemicolectomy was performed and bowel continiuity was established with primary anastomis of remained colonic ends. Postoperative period was uneventfull. Discussion The splenic flexure is strictly attached to the adjacent organs so its volvulus is rare. Most cases of adult SFV have an underlying disease associated with chronic constipation. Diagnosis of volvulus is suspected based on the history, clinical exam, and imaging. The initial and urgent treatment of SFV, if there are no signs of ischemia or perforation, may be conservative with endoscopic detorsion. Gangrenous bowel should not be detorted and should be resected with primary anastomosis or a diverting stoma. Conclusion SFV should be considered as a possible diagnosis of chronic constipation which might be diagnosed with plain abdominal Xray in non emergent condition. Special attention should be given to the medication history of the patient as the anticholinergic agents propagate normal pristaltis.

Splenic flexure volvulus: a rare case report

“…At the level of the splenic flexure, the colon normally has fixed ligamentous attachments to the stomach, spleen and diaphragm. These fixed attachments make the splenic flexure a rare location for the development of volvulus, accounting for 2% of all colonic volvulus [ 2 ].…”

“…Patients present with sudden onset of large bowel obstruction, abdominal pain, distention, constipation, nausea and vomiting [ 2 ]. Physical examination may reveal a palpable abdominal mass and no stool in the rectal vault [ 2 ].…”

“…Three important components that can assist in diagnosis include: patient’s history, examination findings and radiological findings, with CT having the highest sensitivity and specificity [ 2 , 5 ].…”

“…Plain abdominal X-ray typically reveals several characteristic features of SFV, including dilated large bowel loop with sudden termination at the splenic flexure [ 1 , 2 , 5 ]. If a barium enema is performed, a bird’s beak appearance can be seen at the splenic flexure.…”

“…This is most commonly seen in the cecum, or sigmoid colon. A splenic flexure volvulus (SFV) is usually densely attached to its adjacent organs, making it the least common site to develop a colonic volvulus [ 2 ]. Given its rarity, this makes the condition difficult to diagnose, and subsequently result in delays in treatment.…”