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Volvulus of the Transverse Colon.

Sergio Huerta1, Maryanne L Pickett1, Ann M Mottershaw2

  • 1Department of Surgery, VA North Texas Health Care System, Dallas, TX, USA.

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Transverse colonic volvulus (TCV) is a rare cause of large bowel obstruction. Mortality for TCV remains high, necessitating prompt diagnosis and surgical intervention to prevent complications.

Keywords:
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Area of Science:

  • Gastroenterology
  • Surgical Pathology
  • Abdominal Surgery

Background:

  • Transverse colonic volvulus (TCV) is an exceedingly rare cause of large bowel obstruction (LBO), distinct from more common sigmoid and cecal volvulus.
  • Specific involvement of the splenic flexure (SFV) represents an even less common subset of TCV.
  • Understanding TCV's unique presentation, management, and outcomes is crucial given its rarity and potential severity.

Approach:

  • A systematic review of the world literature from 1932 to 2021 was conducted.
  • PRISMA guidelines were followed to identify and analyze all reported cases of TCV.
  • Data from 317 identified cases were analyzed to elucidate trends in TCV.

Key Points:

  • TCV is rare, accounting for less than 1% of colonic volvulus cases, and predominantly affects women in their third decade.
  • Clinical presentation and imaging are consistent with LBO, but conservative management and colonoscopic decompression are less effective than for sigmoid volvulus.
  • Segmental resection was the most common surgical intervention, with a significant overall mortality rate of 20%, often due to cardiopulmonary complications.

Conclusions:

  • Transverse colonic volvulus is an uncommon surgical emergency requiring prompt recognition, often diagnosed intraoperatively.
  • Early diagnosis is critical to prevent ischemic necrosis and perforation.
  • TCV is associated with a higher mortality rate compared to sigmoid and cecal volvulus, highlighting the need for timely and definitive surgical management.