Volvulus of the transverse colon in a child: a case report

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.

Sub-acute transverse colon volvulus an exceptional cause of large bowel obstruction: Case report

Introduction

The sub-acute form of transverse colon volvulus manifests with signs and symptoms of large bowel obstruction. The diagnosis is most often done intraoperatively. We report a rare case of transverse colon volvulus in a 65-year-old female patient with no particular pathological or surgical history.

Case presentation

Sub-acute transverse colon volvulus in an elderly woman with no pathological or surgical history. Manifested with signs and symptoms of colonic obstruction. Surgically treated by a two-stage procedure with good postoperative outcomes.

Discussion

The transverse colon volvulus represents only 2-4% of all colonic volvulus. We discuss the diagnostic and therapeutic approach of our case of transverse colon volvulus through a literature review.

Conclusion

Transverse colon volvulus should be considered as a differential diagnosis in the face of large bowel obstruction. Early diagnosis and treatment improve the prognosis.

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.

Transverse colonic volvulus in a child: successful management with decompression and delayed laparoscopic colopexy

We report a case of colonic volvulus in a 7-year-old child with normal development. Operative findings at laparotomy showed a 270-degree transverse colonic volvulus (TCV), with colonic ligamentous attachment abnormalities. A loop ileostomy was formed following detorsion, with delayed laparoscopic colopexy. This is the first case to describe decompression by diversion ileostomy as acute management of TCV with delayed laparoscopic colopexy, so avoiding unnecessary bowel resection.

Spontaneous transverse colon volvulus

We report a case of spontaneous transverse colon volvulus in a young healthy woman. It constitutes an unusual case since it occurred in a young healthy woman with a subacute onset and no aetiological factor has been found. Its diagnosis is still challenging. Prompt recognition with emergency intervention constitutes the key to successful outcome.

Transverse colon volvulus in a 15 year old boy and the review of the literature

We report a rare case of transverse colon volvulus in a fifteen year old boy with a review of the literature. This brings the total number of pediatric cases reported in the English literature to fifteen. This case is unusual in that no aetiological factor has been found, in contrast to the majority of the pediatric cases. Diagnosis can be challenging and the effective management remains controversial. The various radiological imaging modalities are presented. The epidemiology, aetiology, diagnosis and management of transverse colon volvulus are discussed. It is important to highlight this case and those in the literature, as many surgeons may never have seen a single case of transverse colon volvulus. It may therefore not be considered in the differential diagnosis of recurrent intermittent abdominal pain or acute intestinal obstruction.