Simultaneous Transverse and Sigmoid colon volvulus: A Case report

Abstract

Introduction: Colonic volvulus refers to the axial twisting of the colon on its mesentery, resulting in large bowel obstruction (LBO). The sigmoid colon is most commonly involved (up to 75%), followed by the caecum (22%). Volvulus of the transverse colon and splenic flexure is rare (2% and 1–2%, respectively). Simultaneous volvulus involving multiple colonic segments is extremely uncommon, with very few reported cases. Prompt diagnosis and surgical intervention are essential.

Case Report: A 49-year-old female presented with intermittent crampy abdominal pain for two weeks and failure to pass faeces or flatus for three days. Her abdomen was grossly distended but non-tender, and there were no signs of peritonitis. A plain abdominal X-ray indicated large bowel obstruction, likely secondary to sigmoid volvulus. Rectal tube decompression was attempted but failed. Exploratory laparotomy revealed simultaneous volvulus of both the transverse and sigmoid colon, twisted approximately 270° on their mesenteries. The bowel was viable, and simple detorsion was performed. The patient recovered well and was discharged on the fourth postoperative day.

Discussion: Simultaneous transverse and sigmoid volvulus is an extremely rare but serious cause of LBO. Clinical and radiological findings often overlap with other types of colonic obstruction, and standard imaging may be inconclusive, especially in low-resource settings. Diagnosis is frequently made intraoperatively. Given the increased risk of ischaemia with dual-site volvulus, timely surgical intervention is critical. This rare condition should be considered in the differential diagnosis of LBO when typical signs are absent and initial decompression fails.