Abstract
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.
Highlights
A 75-year old Caucasian male presented to the emergency department with severe abdominal distension and mild dyspnea
The incidence of transverse colon volvulus is relatively rare when compared to cecal volvulus and sigmoid volvulus
Transverse colon volvulus was first categorized by Eisenstat et al as either acute fulminating or subacute progressive [2,3,4,5]
Summary
The incidence of transverse colon volvulus is relatively rare when compared to cecal volvulus and sigmoid volvulus. The term volvulus, derived from the Latin word volvere meaning "to turn," [1] describes the abnormal twisting of the bowel often leading to a closed-loop obstruction. Acute fulminating transverse colonic volvulus is usually described in the setting of marked leukocytosis, acute abdominal pain with rebound tenderness, nausea and vomiting, but limited abdominal distension [3]. The ascending and descending segments of the colon are fixed, but the sigmoid colon, cecum, and transverse colon are mobile within the peritoneum, tethered by their mesentery [2,6,7]. This mobility allows volvulus to occur at these locations. Though generally associated with congenital malrotation [14], an association has been reported with Chilaiditis syndrome [5,6], Clostridium difficile pseudomembranous colitis [2], and impaired intestinal motility associated with pregnancy [15]
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