Case report: transverse colon volvulus in a patient with Clostridium difficile pseudomembranous colitis

Volvulus of the transverse colon in an octogenarian veteran

In the USA, the third leading cause of a large bowel obstruction in adults is volvulus with torsion occurring commonly in the sigmoid and the cecum. Transverse colonic volvulus is exceedingly rare and specific involvement of the splenic flexure is even more uncommon. In the present report, we discuss a Veteran octogenarian who presented with a long-standing history of constipation, but then developed an acute abdomen from a large bowel obstruction. At laparotomy, he had a double closed loop obstruction with volvulus of the splenic flexure. The colon at the splenic flexure was ischemic with patchy areas of necrosis, but no perforation. He underwent a subtotal colectomy with an ileostomy. This case illustrates the need for prompt intervention of this unusual entity. Current trends in the incidence, management, morbidity and mortality are discussed.

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 colonic volvulus after resection of sigmoid volvulus: Presentation of a case report

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Volvulus is a common cause of large bowel obstruction but its metachronous occurrence is an extreme rarity.

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Metachronous transverse colonic volvulus should be eliminated as a differential diagnosis.

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Gangrenous bowel is a life threatening condition and should be dealt with as an emergency situation with the adequate procedure.

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The elective surgical resection should follow optimization of the general condition and set-up.

Introduction

Colonic volvulus is the third leading cause of colonic obstruction in the world following colorectal cancer and complicated sigmoid diverticulitis. Transverse colon is the rarest among other colonic volvulus. Moreover synchronous/metachronous transverse colonic volvulus is extremely rare condition with only few case reported in the literature, we hereby report this case of metachronous transverse colonic volvulus years after sigmoidectomy for sigmoid volvulus

Case presentation

A case of transverse colon volvulus in elderly male with history of chronic constipation and a previous history of a sigmoid volvulus resection few years ago. He presented as an emergency with typical features of acute large bowel obstruction. He was successfully managed with a good out come

Discussion

We discuss the presentation, diagnosis and surgical management with a literature review of this case of a metachronous transverse colonic volvulus.

Conclusion

Metachronous colonic volvulus is an extremely rare cause of large bowel obstruction and should be considered as a differential diagnosis especially in geographic areas with high rate of volvulus or in those with underlying risk factor

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 colon volvulus in a patient with sickle cell disease

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.

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.

Ischemic volvulus of the transverse colon: A case report and review of literature

A 75-year old male presented to the emergency room with worsening abdominal pain and distension. Plain radiographs were suggestive of a large bowel obstruction due to volvulus. An attempt to detorse the volvulus and decompress the colon endoscopically failed, after which the patient was taken for an exploratory laparotomy. A transverse colon volvulus was found, and an extended right hemicolectomy and ileostomy was performed. We discuss the diagnosis and management of transverse colon volvulus and review the pertinent literature.

Eosinophilic colitis

Eosinophilic colitis is a rare chronic inflammatory bowel condition of unknown etiology. We report a case of cecal volvulus causing obstruction in a patient with eosinophilic colitis. A 48-year-old lady presented with abdominal pain, constipation, and abdominal distension. Clinically and radiologically, she was diagnosed to have cecal volvulus. Preoperative colonoscopic reduction failed. At laparotomy, a right hemicolectomy with primary anastomosis was undertaken. Histology of the resected specimen showed diffuse eosinophilic infiltration suggesting eosinophilic colitis. To the best of our knowledge, this association has been never reported.

Prolonged ileus as a sole manifestation of pseudomembranous enterocolitis

BACKGROUND

Pseudomembranous colitis usually manifests as fever and diarrhea in hospitalized patients treated with systemic antibiotics. We present a case that represents a unique variant.

CASE PRESENTATION

The 44-year-old man suffered of several weeks of abdominal pain, low-grade fever, nausea, vomiting, and lack of bowel movements. Upper gastrointestinal barium swallow and passage series revealed evidence of severe intestinal hypomotility. A thorough evaluation for the cause of the patient's ileus and abdominal pain was unrevealing, and symptomatic treatment was ineffective. Following the administration of opiates and dietary fiber supplementation the patient's abdominal pain and distention rapidly worsened, requiring an urgent subtotal colectomy. The macroscopic and microscopic appearance of the excised colon as well as results of the colonic cytotoxin essay and fecal enzyme-linked immunosorbent assay essay confirmed the diagnosis of severe Clostridium difficile induced pseudomembranous colitis as the cause of the patient's illness.

CONCLUSION

To our knowledge, this is the first reported case of Clostridium-difficile induced disease consisting of prolonged ileus in the absence of diarrhea in a patient not previously taking antibiotics.