# Splenic Flexure Volvulus Managed With Left Hemicolectomy and Primary Anastomosis: A Case Report

## TL;DR

A young man with a rare case of splenic flexure volvulus underwent successful left hemicolectomy after laparoscopic treatment failed.

## Contribution

This case report highlights the management of a rare condition with a detailed surgical approach and successful outcome.

## Key findings

- A 720-degree rotation of the splenic flexure was confirmed during laparoscopy.
- Laparoscopic devolution was not feasible due to congenital absence of ligamentous attachments.
- Left hemicolectomy with primary anastomosis led to a good patient recovery.

## Abstract

Volvulus of the splenic flexure is a rare cause of large bowel obstruction. We present the case of a male in his mid-20s who presented with a three-day history of colicky left-sided abdominal pain. A computed tomography scan revealed severely dilated large bowel loops with a closed-loop obstruction in the left upper quadrant, which was thought to originate from the transverse colon. An urgent laparoscopy was performed, and a splenic flexure volvulus was found with a 720-degree rotation around its mesentery. The bowel was viable with no evidence of ischemia or perforation. There was a congenital absence of the splenic flexure ligamentous attachments. It was not possible to safely devolve the volvulus laparoscopically, and the operation was converted to a laparotomy. A left hemicolectomy with a primary anastomosis was performed to remove the pathologically dilated and mobile portion of the bowel. The patient made a good recovery.