Caught in the Whirl: Computed Tomography Diagnosis of Transverse Colon Volvulus With Proximal Jejunal Involvement and...

Transverse colon volvulus is a rare cause of mechanical bowel obstruction, and preoperative diagnosis may be challenging because clinical and radiographic findings are often nonspecific. Computed tomography (CT) plays a central role in identifying the transition point, mesenteric whirl sign, associated bowel involvement, and signs of bowel compromise. We report the case of a 65-year-old man with chronic obstructive pulmonary disease who presented with a five-day history of bowel obstruction, including absence of stool and flatus and vomiting. Upright abdominal radiography showed colonic air-fluid levels, prompting further CT evaluation. Abdominopelvic CT demonstrated marked dilatation of the small bowel and right colon upstream from a left paramedian mesenteric whirl. The volvulus involved the transverse colon, which showed a bird-beak configuration, and an adjacent proximal jejunal loop. The superior mesenteric vein was displaced to the left of the superior mesenteric artery at the level of the twist. Cecocolic pneumatosis was present, suggesting bowel compromise, without pneumoperitoneum, portal venous gas, mesenteric venous gas, or definite mural nonenhancement. Emergency surgery was performed for transverse mesenterico-colic volvulus, and the operative procedure documented ileocecal resection with stoma creation. The patient later underwent ileostomy takedown with manual end-to-end ileocolic anastomosis. This case highlights the value of CT in diagnosing rare volvulus patterns, defining the involved bowel segments, and identifying complications that support urgent surgical management.