Transverse colon volvulus in a 15 year old boy and the review of the literature

This case brings the total number of pediatric transverse colon volvulus reported in the English literature to fifteen. Most pediatric cases have been reported in the United States. Approximately three to five percent of all cases of intestinal obstruction are caused by colonic volvulus [1-4]. The disease is even less common in children. Predisposing factors for transverse colon volvulus in children include mental retardation, dysmotility disorders, lax fixation of the hepatic and splenic flexures, chronic constipation and Hirschsprung's disease [1-7]. There was no predisposing factor in this case unlike the majority which have been reported.A fifteen year old boy presented with a three day history of left sided abdominal pain, constipation and vomiting to the pediatricians. Over the preceding year he had several episodes of intermittent abdominal pain. There was no other significant past medical history. Examination revealed mild tenderness in the epigastrium and left side of the abdomen with moderate distension. Blood investigations revealed normal full blood count, urea and electrolytes, liver function tests, and clotting profile. The C-reactive protein (CRP) was four. An abdominal X-ray (AXR) [Fig. 1] revealed a dilated transverse colon. The distribution of the large bowel dilatation should have raised the possibility of proximal descending colon obstruction. However a computer tomography scan (CT) [Fig. 2] was organised. This revealed dilatation of the proximal transverse colon with a cut-off near the splenic flexure. The appearance was suggestive of a colo-colic intussusception or a volvulus. A surgical review was sought following which a water soluble gastrografin enema was performed for both a therapeutic and diagnostic purpose. This highlighted an obstructive lesion in the proximal descending colon [Fig 3]. No contrast passed beyond this point, and the intended therapeutic benefit was not achieved with the procedure. An emergency laparotomy was performed fo