Case of Transverse colon volvulus presenting as bowel obstruction: a report

Dr Hamza Hasnaoui and colleagues at Visceral Surgery Department A, CHU Hassan II, Fez, Morocco have presented a case of Transverse colon volvulus presenting as bowel obstruction that has appeared in the Journal of Medical Case reports.

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.

On examination, his vital signs were: temperature 37.5 °C, pulse 115/minute, respiratory rate 26/minute, and blood pressure 90/60 mmHg. An abdominal examination revealed massive distension of his abdomen without signs of peritonitis. His abdomen was tympanic to percussion. There were no umbilical or groin hernias. A digital rectal examination demonstrated an empty rectal vault without intraluminal masses. An abdominal X-ray revealed a large bowel obstruction with a “U-shaped” loop in the left upper abdomen (Fig. 1).

Blood investigations showed leukocytosis at 12.0 × 109/L, C-reactive protein (CRP) at 34 mg/l, and serum sodium and potassium levels were within normal limits.

An abdominal CT could not be done due to functional renal failure.

After initial resuscitation with intravenously administered fluids, analgesics, and antibiotics, a decision was taken to proceed with an emergency laparotomy. Intraoperative findings (Fig. 2) were of a transverse colon volvulus rotated in a 360° clockwise direction on its mesentery. The point of twist was found in the left upper quadrant (Fig. 3). The bowel was intact without signs of ischemia (Fig. 4). A significant disparity in the size of the obstructed proximal and collapsed distal colon to the site of the volvulus was noticed. The transverse colon was mobile and increased in length. The volvulus was delivered into the incision and detorsed. An extended right hemicolectomy was carried out with end-to-side ileocolic anastomosis.

Our patient’s postoperative course was uneventful. He was discharged from hospital 6 days following admission. On histologic examination, the appearance was consistent with a subacute progressive volvulus of the transverse colon. No acute inflammation, infarction, granulomas, dysplasia, malignancy, or vascular abnormality was noticed.

Transverse colon volvulus is a rare cause of bowel obstruction in our daily practice. Its diagnosis is challenging. Prompt recognition with emergency intervention constitutes the key to a successful outcome.

For more details click on the link: https://doi.org/10.1186/s13256-019-2080-1