Volvulus of the Transverse Colon

An 81-year-old male was transferred from a local hospital because of leukocytosis and the finding of abdominal guarding on physical examination. Abdominal X-ray and CT revealed marked dilatation of the ascending and transverse colon, with a large amount of ascites. Under the preoperative diagnosis of diffuse peritonitis secondary to colonic obstruction, an emergency laparotomy was performed. At operation, the transverse colon was found to be twisted 360° counterclockwise, with ischemic changes, and was resected partially and anastomosed without colostomy. The postoperative course was uneventful. In a review of the literature, there have been 40 cases of volvulus of the transverse colon reported in Japan, thirteen of which were in subjects with mental retardation or chronic constipation. Twenty-one patients were diagnosed correctly by contrast enema, which is considered clinically useful for the diagnosis. Laparotomy was perfomed in 37 cases, while nonoperative reduction was carried out in 5, including two who underwent palliative colostomy. Etiologically, elongation or hypermobility of the transverse colon has been reported to predispose to volvulus. In 2 cases among ten with a history of laparotomy, adhesion was noted to be the axis of the volvulus, and in 5 other cases, a band caused the volvulus, regardless of the operative history. In our case, chronic constipation and senile dementia might be implicated in the genesis of the volvulus.