Presented By: Dr. Y. Madhu Madhav Reddy,

III Year Post Graduate,Department of Radio Diagnosis,

SRMC & GH, Nandyal.

Transverse Colon

Volvulus

ACADEMIC SES-SION

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.

X ray of Abdomen Erect Chest X ray Erect

Topogram of Abdomen in Supine Position

NCCT of Abdomen

Whirl Sign

Intra Operative Findings

Transverse colon volvulus was confirmed during Surgery

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.

Colonic Volvuli

Cecal Volvulus Transverse colon Volvulus Sigmoid Volvulus

Colonic Volvuli - Radio-graphs

Cecal Volvulus Transverse colon Volvulus Sigmoid Volvulus

Colonic Volvuli - Radio-graphs

Cecal Volvulus Transverse colon Volvulus Sigmoid Volvulus

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, dis-tension, and gradual deterioration. More common in Older individuals.

EtiologiesCONGENITAL PHYSIOLOGICAL MECHANICAL

Redundancy

Non fixation

Long mesentery

High roughage Diet

Elongation and distension 2o Constipation

Megacolon from Hirschsprung disease

Previous volvulus of the trans-verse or the sigmoid colon,

Distal colonic obstruction,Adhesions,

Malposition of the colon following previous surgery,

Mobility of the right colon,

Inflammatory strictures,

Carcinoma.

•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.

• 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%.

• Twisting in volvulus usually occurs along the mesenteric axis of the bowel, resulting in venous obstruc-tion and eventually arterial compromise.

• Compression of the duodenojejunal junction, at the root of its mesentery may cause severe vomiting in this condition.

•Volvulus of sigmoid colon is decompressed colonoscop-ically, but where as volvulus of the transverse colon has to be det-orsed surgically.

•Resection of the affected segment constitutes the treatment of choice to prevent recurrence.

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.

Topogram in Supine position

Transverse ColonAscending colon

Descending Colon and Sig-moid

Conclusion•Transverse colon volvulus is very rare and causes high risk of mortality and morbidity than sigmoid and cecal volvu-lus.

•Diagnosis can be challenging and the effective man-agement remains controversial.

•Prompt recognition by Imaging and with emergency in-tervention constitutes the key to successful outcome.

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

Thank You