Recurrent splenic flexure colonic volvulus: A case report

Large-bowel obstruction (LBO) is an emergency condition that requires early identification and intervention. Among all causes of LBO colonic volvulus is the third leading cause worldwide. Colonic volvulus is an axial rotation of the colon around a fixed point. Splenic flexure volvulus is the least common location for colonic volvulus, accounting for <1 % of cases.

A 41-year-old male patient presented to the emergency department with a history of crampy abdominal pain, abdominal distension and failure to pass feces and flatus of three days duration. He had a history of laparotomy 1 year back, at which time de-rotation of the splenic flexure was done. This time, while preparing the patient for emergency laparotomy, he passed both feces and flatus. On the same admission, he was operated and left hemicolectomy and end to end anastomosis was done.

Due to splenic flexure attachments to the left upper quadrant via Splenic ligament splenic flexure colonic volvulus is very rare. Risk factors include congenitally absent ligaments, congenital bands, acquired adhesions, previous colonic surgery. With the appropriate clinical setting radiographic diagnosis is suggested when there is a markedly dilated, air-filled colon with an abrupt termination at the anatomic splenic flexure, two widely separated air- fluid levels, and an empty descending and sigmoid colon.

Following adequate resuscitation urgent exploratory laparotomy is recommended in splenic flexure volvulus. If the clinical condition of the patient allows colonic resection with continuity restoration is the preferred conventional approach.