Transverse colon volvulus post colonoscopy: a case report

Abstract

Colonic volvulus accounts for 15-20% of large bowel obstructions. A very small percentage of colonic volvulus occur in the transverse colon and splenic flexure (<5%). Colonic volvulus is a surgical emergency and requires urgent decompression to prevent bowel ischaemia and perforation. The incidence of colonic volvulus post colonoscopy is rare, and aetiology is believed to be secondary to insufflation in the context of a non-fixed/mobile segment. We present a case of a 75-year-old man who presented to the emergency department with abdominal pain following a colonoscopy. Computer tomography (CT) imaging of his abdomen demonstrated an acute volvulus of the transverse colon. He proceeded to a diagnostic laparoscopy where the volvulus had resolved. The transverse colon was noted to have redundancy, but both the caecal pole and splenic flexure were fixed. The decision was made not to respect the bowel. Transverse colon volvulus is a rare occurrence, and accurate assessment and investigation of patients presenting with obstructive bowel symptoms is essential to allow prompt surgical management and prevent ischaemia and bowel wall perforation.