Hasnaoui Hamza, Laytimi Faouzi, Elfellah Yusuf, Mouaqit Ouadii, Benjelloun El Bachir, Ousadden Abdelmalek, Taleb Khalid Ait, El Bouhaddouti Hicham
Visceral Surgery Department A, CHU Hassan II, Fez, Morocco.
Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University of Fez, Fez, Morocco.
J Med Case Rep. 2019 May 25;13(1):156. doi: 10.1186/s13256-019-2080-1.
Transverse colon volvulus is an uncommon cause of bowel obstruction. The total number of cases reported in the literature is 100. It constitutes a surgical emergency since it can lead to bowel infarction, peritonitis, and death if not diagnosed at once. It seemed appropriate to report this case that was treated at the Department of Visceral Surgery A, University Hospital Center Hassan II of Fez in Morocco.
We report a rare case of transverse colon volvulus in a 42-year-old Arabic man, with no particular history, who presented to our emergency department with a 5-day history of constipation, progressive abdominal pain, nausea, and vomiting. His last bowel movement had been 3 days ago. Abdominal radiography showed a large bowel obstruction with a "U-shaped" loop in the left upper abdomen. Abdominal computed tomography was not performed because of impaired renal function. He was operated on urgently after conditioning and the diagnosis of a transverse colon volvulus was done intraoperatively. Rotated in a 360° clockwise direction on its mesentery, the bowel was intact without signs of ischemia. An extended right hemicolectomy was carried out with end-to-side ileocolic anastomosis. Through this case, we will try to discuss its physiopathology, etiologies, diagnosis, and management in emergencies.
This case is unusual because no etiological factor has been found. Its diagnosis can be difficult and management effectiveness remains controversial. It is important to highlight this case and those of the literature, as many surgeons may have never seen a case of transverse colon volvulus. Volvulus of the transverse colon may therefore not be considered in the differential diagnosis of recurrent intermittent abdominal pain or acute intestinal obstruction. Prompt recognition with emergency intervention constitutes the key to a successful outcome.
横结肠扭转是肠梗阻的一种罕见病因。文献报道的病例总数为100例。它构成外科急症，因为如果不立即诊断，可导致肠梗死、腹膜炎和死亡。报道这例在摩洛哥非斯哈桑二世大学医学中心A区内脏外科接受治疗的病例似乎是恰当的。
我们报告一例42岁阿拉伯男性横结肠扭转的罕见病例，该患者无特殊病史，因便秘、进行性腹痛、恶心和呕吐5天就诊于我院急诊科。他最后一次排便为3天前。腹部X线检查显示左上腹有一个“U形”肠袢的大肠梗阻。由于肾功能受损未进行腹部计算机断层扫描。在进行相应处理后，他接受了紧急手术，术中诊断为横结肠扭转。肠管沿肠系膜顺时针扭转360°，肠管完整，无缺血迹象。行扩大右半结肠切除术并端端回结肠吻合术。通过这个病例，我们将尝试讨论其生理病理学、病因、诊断及急诊处理。
该病例不常见，因为未发现病因。其诊断可能困难，治疗效果仍存在争议。强调该病例及文献中的病例很重要，因为许多外科医生可能从未见过横结肠扭转病例。因此，横结肠扭转可能未被纳入复发性间歇性腹痛或急性肠梗阻的鉴别诊断中。及时识别并进行紧急干预是取得成功结果的关键。
