A Rare Case of Total Colonic Volvulus

Abstract

Volvulus is a complete twisting of the colon around its mesenteric vasculature, significantly risking obstruction and advancement to ischemic bowel. The most common areas of volvulus are in the sigmoid and cecum; less commonly, volvulus can occur in the splenic flexure and the transverse colon. A rarer situation involves the simultaneous volvulus of the transverse and sigmoid colon. This case report describes a total colonic volvulus involving the terminal ileum to the junction of the descending and sigmoid colon. To our knowledge, only one other similar case has been reported in the English literature. This is the case of a 59-year-old Caucasian female who presented with gastrointestinal bleeding, hypotension, and abdominal pain. Computed tomography (CT) imaging showed colonic thickening with distention extending from the cecum up to the region of the descending-sigmoid junction, which was suggestive of volvulus. An exploratory laparotomy was performed, and infarcted bowel associated with volvulus involving the cecum, ascending colon, transverse colon, and descending colon down to the sigmoid junction was discovered. A subtotal colectomy and ileostomy was performed. Volvulus involving two segments of the colon is a rare event that is diagnosed intra-operatively rather than through pre-operative physical exam and imaging as these modalities are often nonspecific for diagnosing volvulus. It is important for the surgeon to consider the possibility of a volvulus involving more than one segment of colon because of the challenge it presents to the operation and to post-operative management. Regardless of suspected etiology of an acute abdomen, a patient presenting with peritonitis should always undergo an emergent exploratory laparotomy for diagnosis. Volvulus is a complete twisting of the colon around its mesenteric vasculature, significantly risking obstruction and advancement to ischemic bowel. Diagnosis of volvulus is challenging, because physicians may not initially suspect volvulus on their pre-operative assessment as volvulus is often diagnosed intra-operatively. The most common areas of volvulus are in the sigmoid (75%) and cecum (22%); less commonly, volvulus can occur in the splenic

Total colonic volvulus with a 720° twist of freely mobile colon

“…Lehane and Gold state they found in a man in his 50s: “the entire colon was freely mobile without the normal peritoneal attachments” with a 360° twist of infarcted bowel 15. Scheerer and Nazim “noted during the surgery that the mesentery was loose and mobile” and performed a subtotal colectomy for infarction from the caecum to the descending colon, with the creation of an ileostomy 16. The third case is of a man in his 60s with a background of sigmoid resection and acromegaly who experienced abdominal pain for 1 week, and after an unsuccessful attempt at endoscopic decompression proceeded to an operation, which found necrotic colon with a 360° twist requiring total colectomy and end-ileostomy.…”