Unusual case of transverse colon volvulus

1. Presented By:
Dr. Y. Madhu Madhav Reddy,
III Year Post Graduate,
Department of Radio Diagnosis,
SRMC & GH, Nandyal.
Transverse
Colon
Volvulus
ACADEMIC
SESSION

2. Case Report
• A 48yr old male patient, came to the Radiology department, referred by
the Surgery department, SRMC & GH, with complaints of generalised
pain, distension of abdomen and constipation since 5 days.
• No h/o vomiting.
• On examination Bowel sounds were sluggish.
• Patient had no past medical history of chronic constipation, psychiatric
disease, neurologic disease, or abdominal surgery. All the lab reports
were normal.
• The patient was requested X- ray of Abdomen erect.

3. X ray of Abdomen Erect Chest X ray Erect

4. Topogram of Abdomen in Supine Position

5. NCCT of Abdomen

7. Whirl Sign

8. Intra Operative Findings
Transverse colon volvulus was confirmed during Surgery

9. Discussion…
• Volvulus is defined as Twist of the bowel around its own
mesentery, there by causing obstruction to the flow of bowel.
• Only 3 to 5% of all cases of intestinal obstruction are caused
by colonic volvulus.
• Among them, transverse colon is involved in 2 to 4% versus
43 to 80% and 15 to 43% respectively for the sigmoid colon
and the cecum.

10. Colonic Volvuli
Cecal Volvulus Transverse colon Volvulus Sigmoid Volvulus

11. Colonic Volvuli - Radiographs
Cecal Volvulus Transverse colon Volvulus Sigmoid Volvulus

12. Colonic Volvuli - Radiographs
Cecal Volvulus Transverse colon Volvulus Sigmoid Volvulus

13. Forms of Presentation
•The literature describes two forms of presentation:
• Acute fulminating with sudden, severe pain, little distension
and rapid development of shock. More common in younger
patients.
• Subacute progessive with cramping, vomiting, distension, and
gradual deterioration. More common in Older individuals.

14. Etiologies
CONGENITAL PHYSIOLOGICAL MECHANICAL
Redundancy
Non fixation
Long mesentery
High roughage Diet
Elongation and distension
2o Constipation
Megacolon from
Hirschsprung disease
Previous volvulus of the transverse or
the sigmoid colon,
Distal colonic obstruction,
Adhesions,
Malposition of the colon following
previous surgery,
Mobility of the right colon,
Inflammatory strictures,
Carcinoma.

15. •Transverse colon volvulus most often occurs in the second
and third decades of life with an additional peak in
seventh decade.
•Women outnumber men 2:1.

16. • Volvulus of the transverse colon can result in mortality or
significant morbidity relatively more often than cecal or
sigmoid volvulus.
• The mortality rate of transverse colon volvulus is 33%,
where as
• Sigmoid Colon volvulus -- 21%
• Cecal volvulus -- 10%.

17. • Twisting in volvulus usually occurs along the mesenteric
axis of the bowel, resulting in venous obstruction and
eventually arterial compromise.
• Compression of the duodenojejunal junction, at the root
of its mesentery may cause severe vomiting in this
condition.

18. •Volvulus of sigmoid colon is decompressed colonoscopically, but
where as volvulus of the transverse colon has to be detorsed
surgically.
•Resection of the affected segment constitutes the treatment of
choice to prevent recurrence.

19. Another Similar case
•Recently we observed similar findings as in previous
case in a 16 year old female.
•Patient present with complaints of Pain and distension
of abdomen.

20. Topogram in Supine position
Transverse Colon
Ascending colon
Descending Colon
and Sigmoid

22. Conclusion
•Transverse colon volvulus is very rare and causes high risk of
mortality and morbidity than sigmoid and cecal volvulus.
•Diagnosis can be challenging and the effective management
remains controversial.
•Prompt recognition by Imaging and with emergency intervention
constitutes the key to successful outcome.

23. References
•Text book of Current Surgical therapy
•The ASCRS Textbook of Colon and Rectal Surgery: Second Edition
•Text book of gastrointestinal Radiology
•The Radiological Examination of the Colon: Practical Diagnosis By
D.J. Miller, Jovitas Skucas
•The British journal of Radiology
•www.radiographics.rsna.org

24. Thank You