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.
A 42-year-old Arabic man presented to general surgery emergency with a 5-day history of constipation, progressive abdominal pain, nausea, and vomiting. His last bowel movement had been 3 days ago. There was no significant past medical history, particularly of chronic constipation, psychiatric disease, or abdominal surgery.
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.
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