Transverse colon volvulus presenting as bowel obstruction: a case report

Abstract

Background Transverse colon volvulus is an uncommon cause of bowel obstruction. The total number of cases reported in the literature is 100. It constitutes a surgical emergency since it can lead to bowel infarction, peritonitis, and death if not diagnosed at once. It seemed appropriate to report this case that was treated at the Department of Visceral Surgery A, University Hospital Center Hassan II of Fez in Morocco. Case presentation We report a rare case of transverse colon volvulus in a 42-year-old Arabic man, with no particular history, who presented to our emergency department with a 5-day history of constipation, progressive abdominal pain, nausea, and vomiting. His last bowel movement had been 3 days ago. Abdominal radiography showed a large bowel obstruction with a “U-shaped” loop in the left upper abdomen. Abdominal computed tomography was not performed because of impaired renal function. He was operated on urgently after conditioning and the diagnosis of a transverse colon volvulus was done intraoperatively. Rotated in a 360° clockwise direction on its mesentery, the bowel was intact without signs of ischemia. An extended right hemicolectomy was carried out with end-to-side ileocolic anastomosis. Through this case, we will try to discuss its physiopathology, etiologies, diagnosis, and management in emergencies. Conclusion This case is unusual because no etiological factor has been found. Its diagnosis can be difficult and management effectiveness remains controversial. It is important to highlight this case and those of the literature, as many surgeons may have never seen a case of transverse colon volvulus. Volvulus of the transverse colon may therefore not be considered in the differential diagnosis of recurrent intermittent abdominal pain or acute intestinal obstruction. Prompt recognition with emergency intervention constitutes the key to a successful outcome.

Sub-acute transverse colon volvulus an exceptional cause of large bowel obstruction: Case report

“…The first case of transverse colon volvulus to appear in the surgical literature was reported by the Finnish surgeon “Kallio” in 1932 [ 4 ]. The origin of the word “volvulus” comes from the Latin verb “volvere” which means “to turn”.…”

“…The X-ray reveal the presence of a distended colon with two levels of fluid in the epigastrium. In the subacute type, the achievement of an early diagnosis through abdominal CT scan is advised, but it is not recommended in acute settings because it can delay surgical intervention [ 2 , 4 ]. The CT scan findings in our case suggested a volvulus, without being able to identify its exact site, but the diagnostic confirmation was only made intraoperatively.…”

Transverse colon volvulus in a patient with autism

“…The mortality rate of transverse colon volvulus is 33% compared to 21% for sigmoid colon volvulus and 10% for cecum volvulus [ 1–2 ]. Any segment of the colon can get rotated if it has a long loose mesentery which becomes narrow at the base [ 2 , 4 ]. This is less likely to occur in the transverse colon due to its short mesentery and fixed hepatic and splenic flexure [ 1 , 2 ].…”

“…Any segment of the colon can get rotated if it has a long loose mesentery which becomes narrow at the base [ 2 , 4 ]. This is less likely to occur in the transverse colon due to its short mesentery and fixed hepatic and splenic flexure [ 1 , 2 ]. Several predisposing risk factors are history of volvulus, previous surgery involving bowel translocation, malignancy, distal colonic obstruction, adhesions and congenital defects such as intestinal malrotation with an inadequate fixation of posterior abdominal wall, chilaiditis syndrome, Clostridium difficile -associated pseudomembranous colitis, pregnancy and chronic constipation because it causes severe elongation of the transverse colon [ 1–2 , 5–10 ].…”

“…Transverse colon volvulus is an extremely rare cause of bowel obstruction; it constitutes approximately 5% of all causes of bowel obstruction [ 1 ]. There have been ~100 total cases reported in literature [ 2 ]. Transverse colon volvulus presents with signs and symptoms of large bowel obstruction, but it can become a surgical emergency due to bowel infarction or peritonitis [ 1–2 ].…”