J Korean Assoc Pediatr Surg.  2018 Jun;24(1):26-29. 10.13029/jkaps.2018.24.1.26.

Transverse Colon Volvulus around the Gastrostomy Tube in a Pediatric Situs Inversus Patient

• Kang YH
• Youn JK
• Han JW
• Oh C
• Jung SE
• Kim HY

• KMID: 2415883
• DOI: http://doi.org/10.13029/jkaps.2018.24.1.26

Abstract

An 18-year-old male patient with cerebral palsy and scoliokyphosis came to the emergency department with abdominal distension and vomiting. He was a situs inversus patient with a feeding gastrostomy tube. Sigmoid volvulus was initially suspected, so rectal tube insertion and endoscopic decompression were attempted, but failed. So he went through explorative laparotomy, and transverse colonic adhesion and twisting around the gastrostomy tube and gastric wall was identified. Adhesiolysis and resection with redundant transverse colon and end-to-end colocolic anastomosis was performed. He discharged with symptom free. Suspecting transverse colonic volvulus is important when the patient has anatomical anomalies and feeding gastrostomy tube. Timely diagnosis with proper radiologic imaging should be made. Surgical resection of the redundant colon is needed for successful management of transverse colonic volvulus.

Keyword

Intestinal volvulus; Situs inversus; Gastrostomy; Scoliosis

MeSH Terms

Adolescent
Cerebral Palsy
Colon
Colon, Sigmoid
Colon, Transverse*
Decompression
Diagnosis
Emergency Service, Hospital
Gastrostomy*
Humans
Intestinal Volvulus*
Laparotomy
Male
Scoliosis
Situs Inversus*
Vomiting

Figure

• 

  Fig. 1 Right-sided stomach suspecting situs anomaly in upper gastrointestinal series.

• 

  Fig. 2 Diffuse gaseous distension of colon on abdominal X-ray.

• 

  Fig. 3 Adhesion of transverse colon on stomach wall and twisting (arrow) with upstream colon dilatation (arrowhead).

• 

  Fig. 4 Resected redundant transverse colon.

Reference

1. Chen MH, Chou CM, Lin CC. Transverse colon volvulus presenting as ‘inverted’ coffee-bean sign. Arch Dis Child. 2012; 97:123.

2. Elsharif M, Basu I, Phillips D. A case of triple volvulus. Ann R Coll Surg Engl. 2012; 94:e62–e64.

3. Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT. Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World J Gastroenterol. 2014; 20:7739–7751.

4. Al-Homaidhi HS, Tolia V. Transverse colon volvulus around the gastrostomy tube site. J Pediatr Gastroenterol Nutr. 2001; 33:623–625.

5. Liolios N, Mouravas V, Kepertis C, Patoulias J. Volvulus of the transverse colon in a child: a case report. Eur J Pediatr Surg. 2003; 13:140–142.

6. Samuel M, Boddy SA, Nicholls E, Capps S. Large bowel volvulus in childhood. Aust N Z J Surg. 2000; 70:258–262.

7. Onder A, Okur N, Bülbüloğlu E, Yüzbaşioğlu MF. Cecal volvulus in situs inversus totalis accompanied with pancreatic malrotation. Diagn Interv Radiol. 2009; 15:188–192.

8. Ringer PH, Killam AR, Davis BA. Situs inversus viscerum associated with intermittent midgut volvulus. South Med J. 1982; 75:620–623.

9. Waluza JJ, Aronson DC, Nyirenda D, Zoetmulder FA, Borgstein ES. Transverse colon volvulus in children: a case series and a review of the literature. J Pediatr Surg. 2015; 50:1641–1643.

10. Rahbour G, Ayantunde A, Ullah MR, Arshad S, Kerwat R. Transverse colon volvulus in a 15 year old boy and the review of the literature. World J Emerg Surg. 2010; 5:19.