A Case of Proximal Colon Bowel Volvulus after Low Anterior Resection for Rectal Cancer

Abstract

Colonic volvulus is responsible for 4–5% of all cases of intestinal obstruction and most often found in the sigmoid colon, in elderly patients with chronic constipation, where patients develop a large redundant sigmoid colon and with a violation of diet. Twisting and compression of mesenteric blood vessels leads to disruption of intestinal wall nutrition followed by necrosis. Most cases of volvulus require the surgical treatment. Abdominal radiography (barium enema, MSCT) is frequently obtained as the initial diagnostic imaging and has characteristic appearances. We present a case of MRI diagnosis of the colon volvulus after the closure of the transverse loop colostomy after low anterior resection for rectal cancer. The cause of the volvulus was the twisting of the mobilized part of colon with the mesentery when it was lowered into the pelvis. The protective transverse loop colostomy caused the absence of clinical manifestations. After its closure patient was present the clinical features of bowel obstruction and the appearance of MR symptoms typical for this pathology. A retrospective analysis of MR tomograms obtained before the closure of the transverse loop colostomy, allowed revealing of signs of its subclinical ischemia. This case demonstrates the possibilities of MRI in identifying both the typical symptoms of colon volvulus and the signs indicating the possibility of colon twisting in patients after low anterior rectal resection, examined before closing the transverse loop colostomy.