Volvulus of the transverse colon: report of a case

Volvulus of the Transverse Colon

BACKGROUND

In the United States, the third leading cause of a large bowel obstruction (LBO) is colonic volvulus with torsion occurring most commonly in the sigmoid and the cecum. Transverse colonic volvulus (TCV) is exceedingly rare and specific involvement of the splenic flexure (SFV) is even less common. The present analysis was undertaken to interrogate current trends in presentation, management, and outcomes of TCV.

METHODS

In the present report, the world literature was reviewed for the past 90 years (1932 to 2021). We conducted a systematic review to identify all cases of TCV following the PRISMA guidelines.

RESULTS

We identified 317 cases of TCV. This included SFV (n = 75), TCV in pediatric patients (n = 63), TCV in pregnant patients (n = 8), and TCV associated with other pathology such as Chilaiditi's syndrome (n = 11). Compared to sigmoid and cecal volvulus, TCV was rare (.94%). It affected slightly more women (54%) than men, commonly in their third decade of life (37.7 ± 23.8). The clinical presentation and diagnostic imaging were consistent with LBO. Compared to sigmoid volvulus, there was a limited role for conservative management and colonoscopic decompression was less effective. The most common operation was segmental resection (25%). Mortality was (20%) commonly because of cardiopulmonary complications and affected more women (63%). The average age of this cohort was 55.7±24.6 years old.

DISCUSSION

Our review showed that TCV is an uncommon surgical entity. The diagnosis is likely to be made at laparotomy. Prompt recognition is paramount in preventing ischemia necrosis and perforation. Compared to sigmoid and cecal volvulus, the mortality for TCV remains high.

Volvulus of the transverse colon: report of case and review of the literature

A case of transverse colon volvulus is reported, bringing the total number of collected cases in the English language medical literature to 45. Although this type of volvulus is rare, a definite pattern can be appreciated. Patients tend to be young, female, and give a history of chronic or recurrent difficulty in having bowel movements. A triad of underlying factors predisposes to the development of the volvulus: a distal impediment (either organic or functional) to the evacuation of the bowel, a redundant bowel and mesocolon and a fixed point around which the bowel can twist. The best treatment is resection with either anastomosis or exteriorization, depending on bowel viability.

Volvulus of the transverse colon

Volvulus of the transverse colon is a rare condition requiring early diagnosis and treatment. In the absence of ischaemic changes within the redundant bowel, success can be anticipated with conservative fixation procedures. A case is reported which was treated by reduction, decompression and parallel colopexy. Although this disease has been infrequently reported in the past there may well be an increasing incidence with the introduction of high fibre diets and the use of the colonoscope.

Transverse colon volvulus associated with scleroderma

An unusual case of volvulus of the transverse colon associated with scleroderma is presented. The morphologic changes in the large bowel due to progressive systemic sclerosis, resulting in pseudo-obstruction, are considered in the etiology and pathogenesis of colonic torsion.

Volvulus of the transverse colon, a long-term complication of hemicolectomy: report of a case

A redundant limb of ileum left after a hemicolectomy is postulated to be the causative factor in a case of volvulus of the transverse colon and distal ileum after hemicolectomy 20 years before. A case is presented and the etiology of volvulus briefly discussed.

Volvulus of the transverse colon: a postoperative complication of truncal vagotomy and gastrojejunostomy

An instance of volvulus of the transverse colon in the postoperative period following truncal vagotomy and anterior gastrojejunostomy is reported. The clinical features of volvulus of the transverse colon are sudden onset of abdominal colic, distension and vomiting. A plain X-ray film of the abdomen is diagnostic. Laparotomy is recommended, followed by untwisting alone, or untwisting and colostomy when the bowel is viable, or resection with a transverse colostomy and mucous fistula as a first stage when the bowel is gangrenous.