Transverse colon volvulus.

A 59-year-old psychiatric patient presented to the emergency department with abdominal pain especially in the right hypochondriac region, abdominal distension, and vomiting. He has no other medical or surgical history. Abdominal examination reveals a tympanic abdomen especially on the right side. Plain radiograph and a contrast-enhanced computed tomographic (CT) scan were performed subsequently (Fig 1).

Fig 1

CT on the left, plain radiograph on the right. A, Transverse colon volvulus; B, left splenic flexure; C, cecum; D, whirl sign; E, stomach; F, coffee bean sign; and G, cecum.

Question: What is the diagnosis made by contrast-enhanced CT scan?

Transverse colon volvulus

Acute colonic pseudo-obstruction (ACPO)

Acute cholecystitis

Sigmoid volvulus

Answer: A Transverse colon volvulus.

In the plain radiograph, we can identify the coffee bean sign. Typically, it is located in the left side in sigmoid volvulus. However, in this case, it is in the right hypochondric region. Abdominal CT identifies the transverse colon volvulus, with the cecum and left colonic flexure in their anatomical place. A typical whirl sign is seen.

Colic volvulus is a frequent cause of benign mechanical large intestinal obstruction [1]. It most frequently occurs in the sigmoid followed by the cecum [1,2]. Colic flexures and transverse colon volvulus rarely occur, and the literature is sparse concerning these sites of volvulus [1,3]. Guidelines are clear concerning the management of cecal and sigmoid volvulus, whereas reports are controversial about the management of transverse colon volvulus [2]. The controversy is especially concerning whether endoscopic reduction should be attempted initially, such as in sigmoid volvulus. Whereas it is clear that cecal volvulus should not have a trial of endoscopic reduction, the management of transverse colon volvulus is not clear [[1], [2], [3]].

Transverse colon volvulus has also been associated with Chilaiditi syndrome. [3] Plain radiography of these volvuluses shows an upper abdominal coffee bean sign [3]. CT scan, which is the gold standard imaging study, will identify a typical whirl sign, under a bird's beak sign, in volvulus of the transverse colon, with cecum and left splenic flexure in their anatomical place [1,3].

The management of this patient consisted of a right hemicolectomy with ileocolic anastomosis. There was no attempt of endoscopic reduction before surgery. The patient's postoperative phase was uneventful, and he was discharged on the fourth operative day.

Conflict of Interest

None.

Funding Source

None.

Author Contribution

Each listed author contributed to the writing and editing of the manuscript. Dr Valdot edited and described the radiological images.

Ethics Approval

Informed consent was obtained from the participant included in the study.