Volvulus of the splenic flexure: report of a case and review of the literature.

This is the first case report of gangrenous colon from volvulus of the splenic flexure. It is also the first reported treatment of splenic flexure volvulus by exteriorization of the splenic flexure as a loop colostomy. Splenic flexure volvulus has veen a rare cause of mechanical obstruction, producing 1 per cent of colonic volvuluses. Fourteen detailed case reports of splenic flexure volvulus were reviewed. Patients averaged 53.2 years old. Eight of 14 were women. Previous abdominal surgery, anomalies of fixation, and constipation played important roles in the pathogenesis. Diagnosis was made before surgery in two-thirds of the patients. Treatment varied. One patient died without treatment. In two, the volvulus reduced spontaneously. Eleven required emergency surgery. Three underwent operative detorsion, one exteriorization of the splenic flexure as a loop colostomy (the present report), and six partial colectomy. All treated patients survived without recurrence of volvulus. Thus, there was only one death in 14 cases, a seven per cent mortality rate. This low mortality rate was attributed to the rarity of gangrenous colon from splenic flexure volvulus.