Transverse Colon Volvulus

Dr. Y. Madhu Madhava Reddy,Department of Radio Diagnosis,

SRMC & GH, Nandyal.

Case Report• A 48yr old male patient, came to the Radiology department,

referred by Surgery department, SRMC & GH, with complaints of generalised pain, distension of abdomen and constipation since 5 days. No h/o vomitings.

• On examination Bowel sounds were sluggish.• Patient had no past medical history of chronic constipation,

psychiatric disease, neurologic disease, or abdominal surgery. All the lab reports were normal.

• The patient was requested X- ray of Abdomen erect.

Abdomen erect Chest x ray erect

Topogram Abdomen in Supine position

NCCT of Abdomen

Intra Operative Findings

Transverse colon volvulus was confirmed during Surgery

Discussion• Volvulus is defined as Twist of the bowel around its

own mesentery, there by causing obstruction to the flow of bowel.

• Only 3 to 5% of all cases of intestinal obstruction are caused by colonic volvulus.

• Among them, transverse colon is involved in 2 to 4% versus 43 to 80% and 15 to 43% respectively for the sigmoid colon and the caecum.

Caecal Volvulus Sigmoid Volvulus

Forms of presentation• The literature describes two forms of presentation;

acute fulminating and subacute progressive.• Acute fulminating with sudden, severe pain, little

distension and rapid development of shock. More common in younger patients.

• Subacute progessive with cramping, vomiting, distension, and gradual deterioration. More common in Older individuals.

PathogenesisCONGENITAL PHYSIOLOGICAL MECHANICAL

Redundancy

Non fixation

Long mesentery

High roughage Diet

Elongation and distension 2o

Constipation

Megacolon from Hischsprung’s disease

Previous volvulus of the transverse or the sigmoid colon,

Distal colonic obstruction, adhesions,

Malposition of the colon following previous surgery,

Mobility of the right colon,

Inflammatory strictures,

Carcinoma.

• Volvulus of the transverse colon is a rare cause of intestinal obstruction.

• To our knowledge, only 75 cases have been reported in the English literature to date.

• No recent reviews of transverse colon volvulus in adult patients have been published in the surgical literature since 1983.

• Transverse colon volvulus most often occurs in the second and third decades of life with an additional peak in seventh decade.

• Women outnumber men 2:1.

• Volvulus of the transverse colon can result in mortality or significant morbidity relatively more often than caecal or sigmoid volvulus.

• The mortality rate of transverse colon volvulus is 33%, whereas sigmoid volvulus carries a mortality rate of 21% and cecal volvulus a rate of 10%.

• Twisting in volvulus usually occurs along the mesenteric axis of the bowel, resulting in venous obstruction and eventually arterial compromise.

• Compression of the duodenojejunal junction at the root of its mesentery may cause severe vomiting in this condition.

• Volvulus of sigmoid colon is decompressed colonoscopically, but where as volvulus of the transverse colon has to be detorsed surgically.

• Resection of the affected segment constitutes the treatment of choice to prevent recurrence.

Another similar case• Recently we observed similar findings as in

previous case in a 16 year old female.• Patient present with complaints of Pain and

distension of abdomen.

Liver overlap sign

Whirl Sign

Conclusion• Transverse colon volvulus is very rare and causes

high risk of mortality and morbidity than sigmoid and caecal volvulus.

• Diagnosis can be challenging and the effective management remains controversial.

• Prompt recognition with emergency intervention constitutes the key to successful outcome.

References• Text book of gastrointestinal Radiology• Text book of Current Surgical theraphy• The Radiological Examination of the Colon:

Practical Diagnosis By D.J. Miller, Jovitas Skucas

• The ASCRS Textbook of Colon and Rectal Surgery: Second Edition