Transverse Colon Volvulus
Transverse Colon Volvulus
Andrew M. Holloway, MD and Michael T. Langford, MD
Table of Contents
Definition
Transverse Colon Volvulus: Twisting of the Transverse Colon Around Itself
Causes a Closed Loop Obstruction That Can Cause Vascular Compromise with Ischemia, Necrosis, and Perforation
Rare Colonic Volvulus (1-4%)
Much Higher Mortality (3x) than Cecal or Sigmoid Volvulus Due to Late Presentation and High Rates of Ischemia/Perforation
Etiology
Predisposed by a Redundant Transverse Colon and an Elongated Transverse Mesocolon with a Narrow Base
Commonly Associated with Chronic Constipation and a High-Fiber Diet – Lengthens the Intestine and Mesentery to Become Chronically Distended and Redundant
Risk Factors
- Congenital Absence of Colonic Attachments
- Neurologic Disorders
- Psychiatric Disorders
- Male Sex
- Adhesions
- Clostridioides difficile Pseudomembranous Colitis
- Chilaiditis Syndrome
Presentation and Diagnosis
Presentation
- Abdominal Pain
- Abdominal Distention
- Nausea and Vomiting
- Obstipation
Diagnosis
- Generally Diagnosed by CT Abdomen/Pelvis
- Transverse Colon is Dilated and Twisted
- “Whirl Sign” with Mesentery Twisted
- Abdominal Plain Film Can Be Diagnostic But is Neither Sensitive nor Specific
- May See an “Inverted Coffee-Bean Sign” (Dilated Loop of Colon with Apex in the Pelvis)
- Suggestive Plain Film Findings Should Be Further Evaluated by CT
Can Be Diagnosed at Surgical Exploration in an Emergent Setting
Management
The Primary Treatment is Surgical Resection (Extended Right Hemicolectomy vs Transverse Colectomy)
Endoscopic Detorsion Not Recommended