The recurrence of colonic volvulus due to nonrotation after intestinal resection in adulthood: a case report

Metachronous volvulus of the descending colon after resection of the sigmoid volvulus; a case report

INTRODUCTION AND IMPORTANCE

Volvulus of the large bowel is a pathological condition characterized by the twisting of the colon around itself, resulting in obstruction and potentially severe complications such as bowel ischemia and necrosis. The objective of this case report is to highlight the importance of considering volvulus as a differential diagnosis in patients with a history of colonic surgeries, particularly when presenting with symptoms indicative of bowel obstruction.

CASE PRESENTATION

The case was a 55 years old male patient who underwent Hartman procedure three years back for an indication of gangrenous sigmoid volvulus. Three months later the colostomy was reversed and descending colo-rectal end-to-end anastomosis was performed. He currently presented to the emergency department with a one day history of abdominal distension which was progressive and associated with colicky persistent abdominal pain. Exploratory laparotomy was done which showed the descending colon was massively dilated and twisted 360 degree in the counterclockwise direction. The patient was discharged from the ward after one week stay.

CLINICAL DISCUSSION

Despite of the fact that volvulus is the third most common cause of bowel obstruction, consecutive bowel obstruction secondary to volvulus at a separate time and site is an extremely rare phenomenon.

CONCLUSION

A metachronous colonic volvulus is an extremely rare clinical entity. In a patient who presents with bowel obstruction with a history of prior sigmoid colectomy. it is important to consider metachronous volvulus as differential diagnosis specially in patients with significant risk factors or residing in a geographic area known with high rates of volvulus.

Incidental Discovery of Nonrotation in a Patient With Nonspecific Abdominal Pain: A Surgical Diagnostic Dilemma

Intestinal nonrotation is a subtype of malrotation occurring when the midgut fails to rotate before returning to the peritoneal cavity between weeks 8-10 of development. Though sometimes presenting as volvulus during the neonatal period, a subset of patients remains asymptomatic and are identified incidentally as adults. When patients with intestinal nonrotation present with abdominal symptoms, there exists a diagnostic dilemma for the treating surgeon. We present the case of a patient who presented with acute abdominal pain and vomiting, with radiographic findings of intestinal nonrotation and no other acute pathology. Symptoms spontaneously resolved with conservative management for likely etiology of viral gastroenteritis. At the one-month follow-up, the patient had no residual or recurrent symptoms, with no further interventions planned.