eP272 - Idiopathic Concomitant Transverse Colon and Small Bowel Volvulus in Healthy 59-year-old Female

Purpose/Background: Transverse colon volvulus (TCV) is a rare condition that causes mechanical large bowel obstruction. Rarer, are TCVs that are idiopathic in nature and arise in the setting of additional small bowel volvulus. The patient is a 59-year-old female with a history of laparoscopic cholecystectomy and abdominal hysterectomy who was transferred from an outside facility for acute onset abdominal pain with nausea and vomiting that resolved upon arrival. She was in stable condition, with a benign abdominal exam and passing flatus.Methods/Interventions: CT revealed large bowel dilation to greater than 8cm with transition point in the LUQ and additional mesenteric swirl sign suggestive of internal hernia of small bowel. Initially, the patient was taken to the operating room for diagnostic laparoscopy. Upon entry into the abdomen, there was evidence of volvulized transverse colon with apparent congestion and edema notable in the small bowel and the case was converted to an open laparotomy.Results/Outcomes: Small bowel twisted on its mesentery was returned to anatomic position and a redundant portion of the transverse colon near the splenic flexure was identified. Partial colectomy with a side-to-side functional end-to-end anastomosis was created and the anastomosis was returned to the abdominal cavity. She was able to be discharged without complication shortly after.Conclusion/

Discussion: Transverse colonic volvulus is exceptionally rare, with a 0.94% occurrence rate, carrying higher mortality due to delayed diagnosis. Undiagnosed cases can progress to ischemia, necrosis, and perforation, with a 16.9% mortality rate reported for large bowel perforation. Our patient’s idiopathic nature of her volvulus and benign presentation presented a complex diagnostic challenge. In absence of an acute abdominal exam, vital instability, or lab abnormality imaging and gestalt were utilized to correctly idetify this patients emergent pathology and prevent a potentially mortal outcome.CT Coronal of Transverse Colon Volvulus Transition PointCT Coronal cut of the abdomen showing the transition point of the transverse colonic volvulus and twisted mesentery of the small bowel.