3 Years Chronic Simultaneous Separated Triple Large Bowel Volvulus in a Middle Age Female, Very Rare Patient: A Case Report
Authors: Shahraki Ahmad Reza 
Published: January 2025

This case report has been reported in line with the SCARE 2020 criteria. Volvulus of transverse colon is rare when compared to cecal and sigmoid volvulus. Cases involving simultaneous volvulus of the transverse colon and another colonic segment are extremely rare. In adolescent’s sigmoid volvulus is rare and because of this diagnosis is usually missed or delayed. Volvulus is commonly defined as a twisted loop of the intestinal bowel and associated mesentery around a fixed point at its base. Surgery is the main course of treatment for Volvolus, ranging from simple detorsion to right colectomy. Sigmoid volvulus remains an uncommon cause of intestinal obstruction among the adolescent age group. A high index of suspicion is necessary to reach a diagnosis and manage accordingly. Delay in diagnosis can lead to complications such as necrosis and perforation of the twisted colon. Caecal volvulus is a rare cause of bowel obstruction, mainly caused by an exceedingly mobile caecum. Early diagnosis can be difficult due to its unspecific symptoms. Computed tomography plays a major role in a positive diagnosis. The main course of treatment is surgical, and modalities depend on various factors such as patient status and perioperative findings. Nowadays laparoscopic evolution continues to reduce postoperative morbidity. Transverse colon volvulus is an uncommon cause of intestinal obstruction. It is a surgical emergency that can lead to bowel infarction, peritonitis, and death.

Our case was a 52 female just with abdominal distention and we performed CT for her and we find Triple volvulus of large bowel that in history she has signs for 10 days in 3 years before. We operate him and Total colectomy was done and anastomosis of small bowel to rectum and discharge her healthy.

The surgical options in the management of acute large bowel obstruction, as a consequence of transverse colon volvulus, are one- or two-stage procedures. A one-stage procedure includes intraoperative colonic irrigation, resection of non-viable bowel, and primary anastomosis to avoid stoma creation. In a two-stage procedure, two options are available: (1) bowel is resected; the proximal end is brought out as terminal colostomy and distal end as a mucus fistula; 2–3 months’ post-surgery, end-to-end anastomosis is performed and (2) bowel is resected and end-to-end anastomosis is performed; a defunctioning colostomy or a loop ileostomy is fashioned to protect the anastomosis, which is closed 3–4 weeks later. Colonic volvulus usually occurs as a single event that can affect various parts of the colon. The usual sites affected being the sigmoid colon (75%) and the caecum (22%). The phenomenon of multiple sites simultaneously undergoing volvulus is an extremely rare occurrence. The dual location of strangulation makes this situation a major surgical emergency with a high risk of gangrene and septic shock. Colectomy with delayed anastomosis should be preferred in the treatment. Overall, metachronous colonic volvulus must be considered in the differential diagnosis of bowel obstruction, particularly in patients with significant risk factors. Early surgical intervention is essential for better outcome and avoiding complications. A metachronous transverse colonic volvulus is uncommon. Preoperative diagnosis is challenging as there are no defining radiographic features compared to the volvulus of the sigmoid colon with the classical omega sign. Most cases are diagnosed intra-operatively. Bowel resection and anastomosis in a single stage is a safe option. We report this case because in literature we did not find triple and chronic volvulus.