Ascending Colon Volvulus: The Enigma of Double Gastric Bubble

TL;DR

A rare case of ascending colon volvulus in a 54-year-old woman was successfully treated with surgery after timely diagnosis.

Contribution

This case report highlights the importance of early diagnosis in managing a rare surgical emergency.

Findings

Computed tomography revealed a distended large bowel from the left hypochondrium to the left iliac fossa.

Right extended hemicolectomy with ileotransverse anastomosis was performed due to compromised bowel viability.

The patient had an uneventful postoperative recovery and was discharged on the fourth postoperative day.

Abstract

Introduction: Volvulus of the caecum, ascending colon and first third of the transverse colon is a very rare surgical emergency. Timely diagnosis and intervention can avert serious complications.

Case Report: A 54-year-old woman presented to the emergency department with colicky epigastric pain radiating to the left iliac fossa that lasted for 12 h. Vital signs were stable upon arrival at the hospital. Physical examination revealed that left abdomen and suprapubic fullness and bowel sounds were recorded, and rebound tests were negative. Laboratory results were neutrophils: 78% (35%–72%), lymphocytes: 16% (20%–45%), HB: 11 g/dL (12–16), HCT: 33% (36%–48%); all the rest were normal. Furthermore, computed tomography revealed a distended close of the large bowel extending from the left hypochondrium to the left iliac fossa. During explorative laparotomy, volvulus of the first third of the transverse, ascending colon and caecum was detected. Because the viability of the bowel wall was compromised, right extended hemicolectomy was performed with consequent ileotransverse anastomosis. The postoperative period was uneventful, and the patient was discharged on the fourth postoperative day.

Conclusions: Expeditious diagnosis and early intervention of very rare surgical emergencies such as ascending colon volvulus may avert disastrous complications.

Figures