Volvulus of the Transverse Colon in a Child: A Case Report

Abstract

A case of transverse colon volvulus in a 10-year-old female child with trisomy 13 is reported, bringing the total number of cases of children reported in the English language medical literature to 14. Although this type of volvulus is rare, a definite pattern is noticeable, so we should suspect its diagnosis in a patient with chronic constipation, mental retardation and motor disturbances. Resection of the involved segment and primary anastomosis is the definite treatment.

Spontaneous transverse colon volvulus

“…Patients with the acute fulminating type of presentation have a sudden onset of severe abdominal pain, rebound tenderness, vomiting, little distension, and rapid clinical deterioration. Bowel sounds are initially hyperactive becoming absent later on [1, 7]. …”

Transverse colon volvulus in a 15 year old boy and the review of the literature

“…Volvulus is favoured by elongation of the colon, chronic constipation, or by anatomical defects in the normal liver and colon attachments [5]. Thirty three to thirty five percent of children with volvulus of the transverse colon appear to have had a history of chronic constipation [3], which is either idiopathic or secondary to Hirschprung's disease [3,6,7], mental retardation or myotonic dystrophy. Children with mental retardation will tend to have abnormal and irregular bowel function.…”

“…Patients with the acute fulminating type of presentation typically have a sudden onset of severe abdominal pain, rebound tenderness, vomiting, little distension, and rapid clinical deterioration. Bowel sounds are initially hyperactive but may later become absent [3,4]. The acute form presents in sixty percent of children [3].…”

“…Bowel sounds are initially hyperactive but may later become absent [3,4]. The acute form presents in sixty percent of children [3]. Subacute progressive transverse volvulus is associated with massive abdominal distension in the setting of mild abdominal pain without rebound tenderness and little or no nausea or vomiting [4].…”

“…The gold standard of diagnosis is a contrast enhanced plain film which reveals the 'birds beak' phenomenon characteristic of any volvulus. The abdominal film may reveal a large bowel obstruction with proximal colonic distension, two long air-fluid levels and a 'U-shaped' loop with the apex pointing away from the point of torsion of the colon (bent inner tube appearance) [3]. …”