Transverse Colon Volvulus Presenting as Bowel Obstruction: A Rare Case Report

Abstract

Transverse colon volvulus (TVC) is an exceptionally rare cause of large bowel obstruction, accounting for only 2% of colonic volvulus cases (Ciraldo et al., 2000). While sigmoid and cecal volvulus are well-documented, TCV remains a diagnostic and therapeutic challenge due to its infrequency. If left untreated, it can result in catastrophic complications such as bowel ischemia, perforation, and peritonitis. Given its rarity, many gastroenterologists and surgeons may never encounter a case in their clinical practice. We report the case of a 52-year-old male who presented with acute abdominal pain, progressive distension and nausea. Physical examination revealed a distended, tympanic abdomen. Abdominal imaging, including computed tomography (CT), confirmed a volvulized transverse colon with a classic "whirl sign" and significant bowel distension. The patient had a history of chronic constipation but no prior abdominal surgeries. Given the suspicion of ischemic bowel, an emergency laparotomy was performed. Intraoperative findings revealed a gangrenous transverse colon volvulus. The patient succumbed to refractory shock secondary to extensive bowel necrosis, despite maximal surgical and supportive interventions. TCV is a rare but life-threatening cause of large bowel obstruction that requires prompt recognition and intervention. This case underscores the importance of maintaining a high index of suspicion for TCV in patients presenting with unexplained colonic obstruction. Early imaging, timely surgical intervention, and appropriate postoperative management are crucial in optimizing patient outcomes.