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Rare case of rectosigmoid stricture causing transverse colon volvulus.
Kristen Westfall1, Rebecca Brown2, Melissa Chang3
1Surgery, St Joseph Mercy Health System, Ypsilanti, Michigan, USA kristen.westfall@stjoeshealth.org.
BMJ Case Reports
|March 26, 2021
Summary
A 60-year-old woman with a history of sleeve gastrectomy developed altered mental status and was diagnosed with transverse colon volvulus. Surgical intervention led to clinical improvement and discharge.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Critical Care Medicine
Background:
- A 60-year-old woman with a history of sleeve gastrectomy presented with altered mental status following a fall.
- Initial assessment revealed hypothermia, lactic acidosis, leukocytosis, and urinary tract infection, with imaging showing dilated colon.
Observation:
- The patient's condition acutely worsened, prompting flexible sigmoidoscopy to rule out ischemic colitis.
- During the procedure, concern for iatrogenic colon injury arose due to mucosal friability, necessitating exploratory laparotomy.
Findings:
- Intraoperative findings revealed a transverse colon volvulus with extensive patchy gangrene.
- A rectosigmoid stricture with a serosal tear was also identified, but without gross perforation.
Implications:
- The patient underwent an extended left hemicolectomy and end transverse colostomy.
- The surgical intervention resulted in clinical improvement and successful discharge to subacute rehabilitation.
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