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Muacevic A, Adler JR, Prakash S, Vijayakumar C, Kumbhar U. Volvulus of the Transverse Colon Herniated Through Drain Site. Cureus 2023; 15:e34151. [PMID: 36843726 PMCID: PMC9949558 DOI: 10.7759/cureus.34151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 01/25/2023] Open
Abstract
Herniation of the transverse colon and volvulus of it occurring through the previous surgical drain site, presenting as intestinal obstruction, has never been reported. We present an 80-year-old female who complained of abdominal swelling for 10 years. She started developing pain abdomen for 10 days and obstipation for three days. Abdominal examination showed a tender mass in the right lumbar region, with all borders being distinct, and there was no cough impulse. There is a lower midline scar from the previous laparotomy and a small scar over the swelling (drain site). Imaging studies were diagnostic of large bowel obstruction due to the herniation and volvulus of the transverse colon through the previous surgical drain site. She underwent laparotomy, derotation of transverse colon with hernia reduction, and onlay meshplasty. She had an uneventful postoperative course and was discharged.
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Affiliation(s)
- Alexander Muacevic
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - John R Adler
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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Huerta S, Pickett ML, Mottershaw AM, Gupta P, Pham T. Volvulus of the Transverse Colon. Am Surg 2021:31348211041564. [PMID: 34461758 DOI: 10.1177/00031348211041564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Sergio Huerta
- Department of Surgery, 20115VA North Texas Health Care System, Dallas, TX, USA
| | - Maryanne L Pickett
- Department of Surgery, 20115VA North Texas Health Care System, Dallas, TX, USA
| | - Ann M Mottershaw
- Radiology, 20115VA North Texas Health Care System, Dallas, TX, USA
| | - Pramod Gupta
- Radiology, 20115VA North Texas Health Care System, Dallas, TX, USA
| | - Thai Pham
- Department of Surgery, 20115VA North Texas Health Care System, Dallas, TX, USA
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Westfall K, Brown R, Chang M. Rare case of rectosigmoid stricture causing transverse colon volvulus. BMJ Case Rep 2021; 14:14/3/e239809. [PMID: 33766964 PMCID: PMC8006767 DOI: 10.1136/bcr-2020-239809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 60-year-old woman with remote history of sleeve gastrectomy presented with altered mental status after an unwitnessed fall. She was found to be hypothermic with lactic acidaemia, leucocytosis, positive urinalysis, and dilated ascending and transverse colon on cross-sectional imaging, initially thought to be secondary to faecal loading. She was admitted to the medical intensive care unit for resuscitation and broad-spectrum antibiotics for presumed urinary sepsis. She became acutely altered and underwent urgent flexible sigmoidoscopy by gastroenterology to evaluate for ischaemic colitis. During the procedure, there was concern for iatrogenic colon injury given the friability of the colonic mucosa, so the patient was taken urgently for exploratory laparotomy. Intraoperatively, she was found to have a transverse colon volvulus with large areas of patchy, gangrenous bowel without evidence of gross perforation. A rectosigmoid stricture with associated serosal tear, but no full-thickness injury was identified. An extended left hemicolectomy and end transverse colostomy was performed resulting in improvement in the patient's clinical status and eventual discharge to subacute rehab.
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Affiliation(s)
- Kristen Westfall
- Surgery, St Joseph Mercy Health System, Ypsilanti, Michigan, USA
| | - Rebecca Brown
- Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Melissa Chang
- Surgery, St Joseph Mercy Health System, Ypsilanti, Michigan, USA
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Zhao XY, Wang X, Li CQ, Zhang Q, He AQ, Liu G. Intestinal obstruction in pregnancy with reverse rotation of the midgut: A case report. World J Clin Cases 2020; 8:3553-3559. [PMID: 32913863 PMCID: PMC7457094 DOI: 10.12998/wjcc.v8.i16.3553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/30/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Reverse rotation of the midgut is a rare type of intestinal malrotation. Volvulus of the right colon or entire midgut, stenosis of the transverse colon and obstruction of the duodenojejunal junction are common complications of reverse rotation. In this study, we report the first case of intestinal obstruction associated with reverse rotation in pregnancy.
CASE SUMMARY A 31-year-old woman at 36+2 wk gestation presented to the emergency department with progressive abdominal cramping, nausea and bilious vomiting. Abdominal ultrasound scanning showed dilatation of the bowel. Computed tomography scanning revealed features of reverse rotation of the midgut with intestinal volvulus. After consultation with the obstetrician, the pregnancy was terminated and exploratory abdominal surgery was performed. Intra-operatively, it was found that the mesentery of the colon and small intestine was insufficiently attached. The right colon and the small intestinal mesentery was twisted, and intestinal necrosis was observed. The duodenum and duodenojejunal junction were curved in front of the transverse colon, and the transverse colon passed through the tunnel behind the mesenteric root. Intestinal reverse rotation with volvulus was confirmed. The necrotic intestine was resected and small intestine mesenteric reconstruction was performed. The patient recovered after surgery. After leaving the hospital, the patient and her daughter remained well during an 8-month follow-up period.
CONCLUSION We report the diagnosis, treatment and etiology of a pregnant patient with intestinal obstruction due to reverse rotation of the midgut. For similar cases, appropriate diagnosis and treatment should be carried out according to the condition of the fetus and pregnant woman.
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Affiliation(s)
- Xin-Yu Zhao
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xin Wang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Chun-Qiang Li
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Qi Zhang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - An-Qi He
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Gang Liu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
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Midgut Volvulus: A Rare but Fatal Cause of Abdominal Pain in Pregnancy-How Can We Diagnose and Prevent Mortality? Obstet Gynecol Int 2020; 2020:2185290. [PMID: 32547618 PMCID: PMC7271231 DOI: 10.1155/2020/2185290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/09/2020] [Accepted: 05/13/2020] [Indexed: 11/17/2022] Open
Abstract
Midgut volvulus in pregnancy is rare but life-threatening, resulting in high maternal and fetal mortality. This surgical emergency commonly masquerades as symptoms of pregnancy, which together with its low incidence often leads to delay in diagnosis and definitive treatment. Here, we review the last three decades of the literature, discuss the challenges in managing this rare condition, and raise awareness among clinicians to minimise loss of life.
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Sakimura Y, Kitamura H, Inaki N, Bando H. The recurrence of colonic volvulus due to nonrotation after intestinal resection in adulthood: a case report. Surg Case Rep 2019; 5:147. [PMID: 31637559 PMCID: PMC6803607 DOI: 10.1186/s40792-019-0710-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 09/27/2019] [Indexed: 11/10/2022] Open
Abstract
Background Intestinal nonrotation is a rare congenital condition that causes fatal colonic volvulus at any age. Once volvulus attack occurs, radical surgical therapy is required for treatment and the prevention of recurrence. This report describes the case of an adult female patient with a recurrence of cecum volvulus due to intestinal nonrotation after transverse colon resection for colonic volvulus. Case presentation A 27-year-old female visited our emergency room (ER) with intermittent abdominal pain and nausea. Enhanced computed tomography (CT) showed enlargement of the level of the ascending and transverse colon and an obstruction with a whirlpool sign at the transverse colon. The small intestine was distributed on the right side of the abdominal cavity, and the large intestine occupied the left side. She was diagnosed with volvulus with intestinal nonrotation, and emergency surgery was performed. Surgical examination indicated that the ascending colon to the transverse colon was not fixed to the retroperitoneum, and the transverse colon was rotated 180° clockwise. The axis of the volvulus was a mesenteric adhesion of the transverse colon. The involved transverse colon was resected, and the intestine was reconstructed by functional end-to-end anastomosis (FEEA). Six years after the initial surgery, the patient presented to the ER with abdominal fullness and lower abdominal pain. Enhanced CT revealed that the cecum, ascending colon, and remaining transverse colon were dilated with an obstruction. The appendix was located in the left upper abdominal cavity. The clinical diagnosis was cecal volvulus with intestinal nonrotation. An emergency laparotomy revealed that the cecum was rotated 180° clockwise. The terminal ileum to the remaining transverse colon was resected, and FEEA was performed. Seven months later, she suffered obstruction of the intestine caused by an operative adhesion, and conservative treatment was successful. The patient has had no abdominal symptoms for one and a half years so far. Conclusions Surgeons should realize that nonrotation of the intestines induces volvulus in adulthood and should familiarize themselves with its clinical findings, appropriate treatment, and prognosis. Even after surgical treatment, awareness of the recurrence of volvulus should be maintained to avoid a late diagnosis.
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Affiliation(s)
- Yusuke Sakimura
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, 2-1 Kuratuki Higashi, Kanazawa, Ishikawa, 9208530, Japan.
| | - Hirotaka Kitamura
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, 2-1 Kuratuki Higashi, Kanazawa, Ishikawa, 9208530, Japan
| | - Noriyuki Inaki
- Department of Surgery, Juntendo Urayasu Hospital, Juntendo University, 2-1-1, Tomioka, Urayasu-shi, Chiba, 2790021, Japan
| | - Hiroyuki Bando
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, 2-1 Kuratuki Higashi, Kanazawa, Ishikawa, 9208530, Japan
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Abdulla HA, Hamza E, Dhaif A. Transverse colon volvulus in a patient with sickle cell disease. BMJ Case Rep 2019; 12:12/3/e228863. [PMID: 30852505 DOI: 10.1136/bcr-2018-228863] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Although colonic volvulus is a relatively rare cause of large bowel obstruction, accounting for up to 5% of all cases of intestinal obstruction, transverse colon volvulus is extremely uncommon compared with volvulus of the sigmoid colon or caecum and is responsible for only 3% of all reported cases. We report an unusual case of spontaneous volvulus of the transverse colon in a young man with sickle cell disease who underwent resection with primary anastamosis. Having a high index of suspicion and early operative intervention allowed for this patient to have an uneventful postoperative course.
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Affiliation(s)
| | - Eman Hamza
- Department of General Surgery, King Hamad University Hospital, Busaiteen, Bahrain
| | - Ali Dhaif
- Department of Surgery, Salmaniya Medical Complex, Manama, Bahrain
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Bullen A, Lewin J, Cross T, Woolven B. A case report of a rare and challenging gangrenous splenic flexure volvulus in a pregnant patient. Int J Surg Case Rep 2018; 53:171-174. [PMID: 30408739 PMCID: PMC6222078 DOI: 10.1016/j.ijscr.2018.10.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/21/2018] [Accepted: 10/25/2018] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Splenic flexure volvulus is a rare cause of intestinal obstruction and is uncommonly encountered in young patients from developed countries. PRESENTATION OF CASE This report details a challenging case of a gangrenous large bowel volvulus in a 25 year old woman 20 weeks pregnant, highlighting the diagnostic and operative challenges that this rare clinical situation presents. After urgent MRI confirming a splenic flexure volvulus, an emergency open left hemicolectomy and end colostomy was performed. Following uneventful recovery and successful delivery of her baby at full term, she was reversed 6 months later. DISCUSSION Splenic flexure volvulus is a rare cause of large bowel obstruction, and as such can result in a delay in diagnosis, particularly in the setting of pregnancy. In this case, the patient was not diagnosed until day 3 of her admission when she decompensated with a rising white cell count. CONCLUSION Splenic flexure volvulus is a rare occurrence. This case report of a young pregnant woman presenting with a large bowel obstruction due to splenic flexure volvulus highlights the importance of considering and investigating for this diagnosis.
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Affiliation(s)
| | - Joel Lewin
- University of Queensland, Brisbane, QLD, Australia
| | - Trent Cross
- James Cook University, Cairns Base Hospital, QLD, Australia
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Reversed Intestinal Rotation Presented as Bowel Obstruction in a Pregnant Woman. Case Rep Surg 2015; 2015:870437. [PMID: 26075133 PMCID: PMC4449921 DOI: 10.1155/2015/870437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 04/26/2015] [Indexed: 12/30/2022] Open
Abstract
A rare case of complete large bowel obstruction in a pregnant woman, without previous surgical history, due to previously undiagnosed reversed intestinal rotation is presented. The young woman was admitted with progressive nausea and vomiting which did not respond to conventional therapy. Her plain abdominal film revealed signs of small bowel obstruction. On laparotomy, her transverse colon was found to be located beneath the root of small bowel mesentery and completely obstructed by congenital fibrous bands. Postoperative recovery was unremarkable. Surgery for this unusual developmental anomaly is discussed.
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Cong Q, Li X, Ye X, Sun L, Jiang W, Han Z, Lu W, Xu H. Small bowel volvulus in mid and late pregnancy: can early diagnosis be established to avoid catastrophic outcomes? Int J Clin Exp Med 2014; 7:4538-4543. [PMID: 25550984 PMCID: PMC4276242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 10/30/2014] [Indexed: 06/04/2023]
Abstract
Volvulus in pregnancy is rare and difficult to diagnose. Delayed diagnosis would result in high maternal and fetal mortality. Here we present an unusual case of small bowel volvulus in late pregnancy timely managed by emergency Cesarean section and derotation with excellent maternal and fetal outcomes. Volvulus should be considered in patients complaining ongoing abdominal pain, nausea, vomiting, constipation even diarrhea. Imaging is essential for early and precise diagnosis, including plain abdominal film, MRI and/or ultrasound. Once highly suspected or diagnosed of volvulus or ileus, emergency laparotomy should be performed immediately to avoid catastrophic outcomes, because the maternal and fetal prognosis is dependent on the interval from volvulus to operation apart from the degree of volvulus.
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Affiliation(s)
- Qing Cong
- Obstetrics and Gynecology Hospital of Fudan UniversityShanghai, P. R. China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related DiseasesShanghai, P. R. China
| | - Xilian Li
- Obstetrics and Gynecology Hospital of Fudan UniversityShanghai, P. R. China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related DiseasesShanghai, P. R. China
| | - Xuping Ye
- Obstetrics and Gynecology Hospital of Fudan UniversityShanghai, P. R. China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related DiseasesShanghai, P. R. China
| | - Li Sun
- Obstetrics and Gynecology Hospital of Fudan UniversityShanghai, P. R. China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related DiseasesShanghai, P. R. China
| | - Wei Jiang
- Obstetrics and Gynecology Hospital of Fudan UniversityShanghai, P. R. China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related DiseasesShanghai, P. R. China
| | - Zhigang Han
- Obstetrics and Gynecology Hospital of Fudan UniversityShanghai, P. R. China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related DiseasesShanghai, P. R. China
| | - Weiqi Lu
- Zhongshan Hospital of Fudan UniversityShanghai, P. R. China
| | - Huan Xu
- Obstetrics and Gynecology Hospital of Fudan UniversityShanghai, P. R. China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related DiseasesShanghai, P. R. China
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Patel RV, Njere I, Campbell A, Daniel R, Azaz A, Fleet M. Sigmoid volvulus in an adolescent girl: staged management with emergency colonoscopic reduction and decompression followed by elective sigmoid colectomy. BMJ Case Rep 2014; 2014:bcr-2014-206003. [PMID: 25143313 PMCID: PMC4139550 DOI: 10.1136/bcr-2014-206003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A case of acute sigmoid volvulus in a 14-year-old adolescent girl presenting with acute low large bowel obstruction with a background of chronic constipation has been presented. Abdominal radiograph and CT scan helped in diagnosis. She underwent emergency colonoscopic detorsion and decompression uneventfully. Lower gastrointestinal contrast study showed very redundant sigmoid colonic loop without any transition zone and she subsequently underwent elective sigmoid colectomy with good outcome. The sigmoid volvulus should be considered in the differential diagnosis of paediatric acute abdomen presenting with marked abdominal distention, absolute constipation and pain but without vomiting. Plain abdominal radiograph and the CT scan are helpful to confirm the diagnosis. Early colonoscopic detorsion and decompression allows direct visualisation of the vascular compromise, assessment of band width of the volvulus and can reduce complications and mortality. Associated Hirschsprung's disease should be suspected if clinical and radiological features are suggestive in which case a rectal biopsy before definitive surgery should be considered.
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Affiliation(s)
- Ramnik V Patel
- Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Paediatric Urology, Great Ormond Street Children Hospital NHS Trust, London, UK
| | - Ike Njere
- Department of Paediatric Surgery, Hull Royal Infirmary, Hull, Yorkshire, UK
| | - Alison Campbell
- Department of Paediatric Surgery, Hull Royal Infirmary, Hull, Yorkshire, UK
| | - Rejoo Daniel
- Department of Paediatric Surgery, Hull Royal Infirmary, Hull, Yorkshire, UK
| | - Amer Azaz
- Department of Paediatric Surgery, Hull Royal Infirmary, Hull, Yorkshire, UK
| | - Mahmud Fleet
- Department of Paediatric Surgery, Hull Royal Infirmary, Hull, Yorkshire, UK
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