Volvulus of the transverse colon.

Abstract

Volvulus of the transverse colon constitutes one of the rarest forms of mechanical obstruction of the large bowel, and reliable radiologic documentation of such an accident occurring in a normally developed colon (excluding anomalies of rotation) is indeed unusual. Kallio (10), in 1932, collected 18 cases, including 2 from his own experience, and stated that, although uncommon, volvulus of this type was possible in the presence of an extremely redundant transverse colon whose flexures were in unusually close proximity; the torsion mechanism thus was similar to that occurring in the sigmoid. Kallio furnished an excellent review of the literature and the reader is referred to his paper for references to the earlier cases. The only subsequent contributions dealing with this condition are single case reports by Groth (8) in 1934, Melchior (13) in 1934, Martin and Ward (12) in 1944, Tabanelli (18) in 1947, Olivier and Libaude (15) in 1948, Murray (14) in 1950, and a report of 2 cases by Buenger (3) in 1954. Upon analysis of the descriptive and illustrative material in the papers of Melchior and Murray it is readily apparent that anomalies of rotation existed in their cases prior to the development of volvulus. Copies of roentgenograms submitted by Tabanelli strongly contradict the surgical impression of volvulus, since a barium enema study demonstrated filling of the transverse colon, including both flexures, without revealing unusual redundancy or obstruction. Possibly a redundant looplike right colonic segment was twisted at its base, as has been reported by Homans (9). Even this possibility cannot be accurately established from the radiographs shown. The cases of Groth, of Martin and Ward, and of Olivier and Libaude, appear to constitute duly authenticated examples of volvulus of the transverse colon. In the case of Groth, the diagnosis of axial torsion was established by preliminary barium enema examination demonstrating a funnel-shaped obstruction in the proximal half of the transverse colon just to the right of the mid-line, with a detailed study showing spiraling and crossing of mucosal folds at that site. This obstruction was overcome with some difficulty, with barium filling the proximal colon. The torsion was apparently reduced during expulsion of the enema and recurred a few days later. Groth considers this to be a physiological type of torsion, which on occasions may be associated with obstructive symptoms. The case of Olivier and Libaude showed a rounded termination of the barium column, with a dentate margin, at the site of obstruction in the distal transverse colon and a severely distended, redundant transverse colon proximally. At surgery a torsion of 180° was present.