Transverse to Descending Colon Volvulus and Megacolon with Mesenterium Commune: Report of a Case

Recurrent Transverse Colon Volvulus After Operative Detorsion: A Case Report

Transverse colon volvulus is a rare type of colonic volvulus. Here, we present a case of a 40-year-old male patient with a recurrent transverse colon volvulus after operative detorsion. He presented with a history of intermittent crampy abdominal pain of three days duration associated with failure to pass both feces and flatus. He has a history of abdominal distention and vomiting. The patient has a history of repeated abdominal surgeries. His last surgery was two years before the presentation, laparotomy with operative detorsion without colopexy for viable transverse colon volvulus. The patient was explored, and transverse colectomy was done with two-stage procedures. The transverse colon volvulus can occur simultaneously or metachronously with other types of colonic volvulus. A high index of suspicion is needed for diagnosis. Management of transverse colon volvulus should be resection with or without primary anastomosis.

An unusual presentation of transverse colon volvulus in a patient with Williams Syndrome: Case report and literature review

Introduction

and Importance: Williams Syndrome (WS) is a well-recognized genetic disorder characterized by multi-system clinical manifestations. However, there are very rare gastrointestinal complications associated with patients with Williams Syndrome. We report the first transverse colon volvulus (TCV) case in an adult with pre-diagnosed Williams Syndrome.

Case presentation

We report a case of a 22-year-old South Asian adult who presented with complaints of generalized progressive abdominal pain, distension, bilious vomiting, and constipation. Detailed history, physical examination, and radiological investigations confirmed the diagnosis of transverse colon volvulus. A subtotal colectomy with end-to-end anastomosis was done.

Conclusion

Patients with Williams Syndrome can develop rare gastrointestinal complications like transverse colon volvulus due to congenital/physiological predisposing factors. It is a surgical emergency and should be diagnosed and managed optimally. In addition, physicians should keep TCV in differential diagnoses while dealing with patients of Williams Syndrome presenting with acute or subacute abdominal pain.

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There are very rare gastrointestinal complications associated with patients with Williams Syndrome.

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This case report bridges a void in the existing medical literature regarding the gastrointestinal complications of Williams Syndrome.

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Physicians should keep TCV in differential diagnoses while dealing with patients of Williams Syndrome presenting with acute or subacute abdominal pain.

Volvulus of the transverse colon after resection of the sigmoid volvulus: A case report

Sigmoid volvulus is a common cause of colon obstruction, while volvulus of the transverse colon rarely causes bowel obstruction. The occurrence of transverse colon volvulus after resection of the sigmoid colon volvulus is extremely rare. This report presents a 73-year-old man who presented with abdominal pain and peritonitis. The patient underwent exploratory laparotomy, and sigmoid volvulus and cecum perforation were confirmed. A right hemicolectomy, end-to-side ileotransverse colon anastomosis for the cecal perforation, and sigmoidectomy with end-colostomy (Hartmann's procedure) for the sigmoid volvulus were performed. A month later, the patient returned to the emergency room with abdominal distention and the blockage of colostomy. Abdominal CT revealed a transverse colon volvulus. A transverse and descending colon resection and ileorectal anastomosis were performed. The patient’s condition was stable at the time of discharge from the hospital. The management of metachronous colon volvulus should include surgical intervention. If patients are not diagnosed immediately, their condition may deteriorate dramatically because of bowel infarction or peritonitis. It is essential to highlight this case, as many surgeons may not have attended a transverse colon volvulus after sigmoid volvulus, which might lead to high morbidity or mortality. Overall, metachronous colonic volvulus must be considered in the differential diagnosis of bowel obstruction, particularly in patients with significant risk factors.

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.

Ischemic volvulus of the transverse colon caused by intestinal malrotation: A case report

Introduction

Congenital Intestinal malrotation is a complex disorder caused by incomplete or abnormal rotation of the intestine during fetal development. Volvulus of the transverse colon secondary to intestinal malrotation is a rare cause of acute abdomen in adults. It has a high risk of mortality, hence the need for an urgent diagnosis and surgical intervention.

Case report

We report an unusual case of volvulus of the transverse colon caused by intestinal malrotation. A 21-year-old women presented abdominal pain with nausea and vomiting. On clinical examination, the abdomen was tympanic to percussion with peritoneal sensitivity. The abdominal X-ray revealed a massive obstruction of the distended large intestine with a “U-shaped” loop. He underwent an exploratory laparotomy that revealed the diagnosis of transverse colon volvulus with intestinal malrotation. His condition was treated surgically by transverse colectomy with colostomy. The patient died on the second day following a hemodynamic instability.

Conclusion

Transverse colonic volvulus is a rare entity with a high mortality, so it requires urgent diagnosis and surgical intervention.

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Volvulus of the transverse colon secondary to intestinal malrotation is a rare cause of an acute abdomen in adults.

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Volvulus of the transverse colon has a high risk of mortality, so it requires urgent diagnosis and surgical intervention.

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The diagnosis of the volvulus of the transverse colon before surgery is rarely observed, it's most often made intraoperatively.

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The choice of a procedure depends on the general condition of the patient.

Transverse colon volvulus in a patient with autism

Transverse colon volvulus is an extremely rare cause of bowel obstruction with approximately 100 cases reported in literature. 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. We present a rare case of transverse colon volvulus in a 36-year-old male patient with severe autism. We hope this case report will raise awareness of this disease.

Transverse colon volvulus presenting as bowel obstruction: a case report

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.

Ileus associated with mesenterium ileocolicum commune: two case reports and review of the literature

Two cases of ileus associated with mesenterium ileocolicum commune are reported herein. Case 1 was a 6-year-old girl who was admitted with bilious vomiting and abdominal distension. Plain computed tomography (CT) suggested intestinal volvulus or intussusception. A barium enema revealed an incomplete obstruction or stricture. She underwent a laparotomy. The intra-operative findings revealed midgut volvulus associated with mesenterium ileocolicum commune with normal rotation of the intestine. The volvulus was 180 degrees of counter-clockwise torsion. Case 2 was a 3-year-old boy who was admitted with bilious vomiting. Enhanced CT suggested a duodenal obstruction. A barium meal revealed malrotation and it was difficult to insert an enteral feeding tube into the small intestine. He underwent a laparotomy, and the intra-operative findings revealed Ladd’s bands associated with mesenterium ileocolicum commune and malrotation of the intestine. At present, both patients are doing well and there have been no recurrences.

Multidetector computed tomography diagnosis of splenic flexure volvulus: usefulness of multiplanar reformats

Splenic flexure volvulus is the least common form of colonic volvulus. Preoperative radiological diagnosis is usually made presumptively, based on plain radiographs and/or barium contrast enema study in patients presenting with acute large bowel obstruction. We report a case in which multidetector computer tomography (CT) findings were diagnostic of this condition, thus highlighting the usefulness of multiplanar reformatting.