Volvulus of the Transverse Colon

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.