Chinisaz Fatemeh, Asefi Hoda, Miratashi Yazdi Seyed Amir
Students' Scientific Research Center, Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran.
Department of Radiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
J Taibah Univ Med Sci. 2021 Sep 24;17(4):626-629. doi: 10.1016/j.jtumed.2021.08.011. eCollection 2022 Aug.
Sigmoid volvulus is a common cause of colon obstruction, while volvulus of the transverse colon rarely causes bowel obstruction. The occurrence of transverse colon volvulus after resection of the sigmoid colon volvulus is extremely rare. This report presents a 73-year-old man who presented with abdominal pain and peritonitis. The patient underwent exploratory laparotomy, and sigmoid volvulus and cecum perforation were confirmed. A right hemicolectomy, end-to-side ileotransverse colon anastomosis for the cecal perforation, and sigmoidectomy with end-colostomy (Hartmann's procedure) for the sigmoid volvulus were performed. A month later, the patient returned to the emergency room with abdominal distention and the blockage of colostomy. Abdominal CT revealed a transverse colon volvulus. A transverse and descending colon resection and ileorectal anastomosis were performed. The patient's condition was stable at the time of discharge from the hospital. The management of metachronous colon volvulus should include surgical intervention. If patients are not diagnosed immediately, their condition may deteriorate dramatically because of bowel infarction or peritonitis. It is essential to highlight this case, as many surgeons may not have attended a transverse colon volvulus after sigmoid volvulus, which might lead to high morbidity or mortality. Overall, metachronous colonic volvulus must be considered in the differential diagnosis of bowel obstruction, particularly in patients with significant risk factors.
乙状结肠扭转是结肠梗阻的常见原因,而横结肠扭转很少导致肠梗阻。乙状结肠扭转切除术后发生横结肠扭转极为罕见。本报告介绍了一名73岁男性,他因腹痛和腹膜炎就诊。患者接受了剖腹探查术,证实为乙状结肠扭转和盲肠穿孔。对盲肠穿孔进行了右半结肠切除术、回肠-横结肠端侧吻合术,对乙状结肠扭转进行了乙状结肠切除术并端侧结肠造口术(哈特曼手术)。一个月后,患者因腹胀和结肠造口堵塞返回急诊室。腹部CT显示横结肠扭转。进行了横结肠和降结肠切除术及回肠直肠吻合术。患者出院时情况稳定。异时性结肠扭转的治疗应包括手术干预。如果患者未立即得到诊断,其病情可能因肠梗死或腹膜炎而急剧恶化。强调该病例很重要,因为许多外科医生可能未曾见过乙状结肠扭转后发生横结肠扭转的情况,这可能导致高发病率或死亡率。总体而言,在肠梗阻的鉴别诊断中必须考虑异时性结肠扭转,尤其是在有显著危险因素的患者中。