|IMAGES IN ACADEMIC MEDICINE: REPUBLICATION
|Year : 2017 | Volume
| Issue : 3 | Page : 198-199
Colonic “double twist”
Jonathan R Wisler1, Stanislaw P Stawicki2
1 Department of Surgery, Division of Critical Care, Trauma, and Burn, The Ohio State University Medical Center, Columbus, Ohio, USA
2 Department of Surgery, Division of Critical Care, Trauma, and Burn, The Ohio State University Medical Center; OPUS 12 Foundation, Columbus, Ohio, USA
|Date of Web Publication||21-Apr-2017|
Stanislaw P Stawicki
Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, PA 18015
Source of Support: None, Conflict of Interest: None
A case of a middle-aged man with simultaneous sigmoid and transverse colonic volvuli is described. Preoperative radiograph and intraoperative photographs are presented. A discussion of simultaneous volvuli involving more than one colonic segment then follows, including diagnostic and treatment considerations.
The following core competencies are addressed in this article: Patient care, Medical knowledge.
Republished with permission from: Wisler JR, Stawicki SPA. Interesting clinical image: Colonic “double twist”. OPUS 12 Scientist 2009;3(3):58-59.
Keywords: Clinical diagnosis, colonic volvulus, diagnostic imaging, multiple volvuli, sigmoid colon, transverse colon, treatment
|How to cite this article:|
Wisler JR, Stawicki SP. Colonic “double twist”. Int J Acad Med 2017;3, Suppl S1:198-9
| Introduction and Case Presentation|| |
A middle-aged man presented to the Emergency Department with 24 h of progressively worsening acute on chronic abdominal pain. The patient denied fevers, chills, nausea, or vomiting but noted worsening constipation for approximately 4–5 days. He also related a history of baseline chronic abdominal distention. Physical examination at presentation revealed mild diffuse abdominal tenderness without peritoneal signs. The patient had a nasogastric tube placed for bowel decompression and was admitted for observation. Over the next 2 days, the patient had progressive obstipation and increasing abdominal pain. Abdominal radiograph on hospital day 2 demonstrated dilated loops of bowel consistent with “coffee bean” or “bent inner tube” sign [Figure 1], and diagnosis of colonic volvulus was made.
|Figure 1: Acute abdominal series demonstrates “coffee bean” or “bent inner tube” sign|
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Exploratory laparotomy revealed simultaneous presence of transverse and sigmoid colonic volvuli [Figure 2]. The affected segments were resected, and an end-transverse colostomy was created. The patient was discharged after an uneventful 5-day postoperative recovery. He was doing well on subsequent outpatient follow-up.
|Figure 2: Intraoperative photographs showing double colonic volvulus. Note that both the transverse and the sigmoid colonic segments are involved. The small bowel is seen projecting toward the right side of the surgical field|
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| Discussion and Conclusions|| |
Transverse colonic volvulus is very rare.,, Cases involving simultaneous volvulus of the transverse colon and another colonic segment are exceedingly rare.,, In single-site colonic volvulus, the most common location is the cecum (52%), followed by sigmoid colon (43%), transverse colon (3%), and splenic flexure. The overall mortality may be as high as 14%., Predisposing factors for colonic volvulus include history of multiple intra-abdominal adhesions, congenital malformations or absent ligamentous fixation of the colon, and acquired megacolon (i.e., delayed presentation of Hirschsprung's or Chagas disease).
Dolichocolon is a clinical condition involving elongation and dilation of the colon, most commonly seen in elderly patients. It has been suggested that these patients should also be considered to be at increased risk for the development of colonic volvulus. In the absence of clinical or radiologic signs of perforation or necrosis, initial management of the colonic volvulus may include colonoscopic derotation and decompression. Successful endoscopic therapy provides an opportunity to perform an elective resection of the involved colonic segment, following adequate bowel preparation and any required nonsurgical preoperative optimization (i.e., cardiac and respiratory clearance). Emergent surgery should be performed if endoscopic therapy is unsuccessful, if complete obstruction persists for more than 24 h, if peritonitis or perforation develop during the observation period, or whenever ischemia or necrosis cannot be ruled out.
Justifications for re-publishing this scholarly content include: (a) The phasing out of the original publication after a formal merger of OPUS 12 Scientist with the International Journal of Academic Medicine and (b) Wider dissemination of the research outcome(s) and the associated scientific knowledge.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]