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Rare case of rectosigmoid stricture causing transverse colon volvulus
  1. Kristen Westfall1,
  2. Rebecca Brown2 and
  3. Melissa Chang1
  1. 1Surgery, St Joseph Mercy Health System, Ypsilanti, Michigan, USA
  2. 2Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Kristen Westfall; kristen.westfall{at}stjoeshealth.org

Abstract

A 60-year-old woman with remote history of sleeve gastrectomy presented with altered mental status after an unwitnessed fall. She was found to be hypothermic with lactic acidaemia, leucocytosis, positive urinalysis, and dilated ascending and transverse colon on cross-sectional imaging, initially thought to be secondary to faecal loading. She was admitted to the medical intensive care unit for resuscitation and broad-spectrum antibiotics for presumed urinary sepsis. She became acutely altered and underwent urgent flexible sigmoidoscopy by gastroenterology to evaluate for ischaemic colitis. During the procedure, there was concern for iatrogenic colon injury given the friability of the colonic mucosa, so the patient was taken urgently for exploratory laparotomy. Intraoperatively, she was found to have a transverse colon volvulus with large areas of patchy, gangrenous bowel without evidence of gross perforation. A rectosigmoid stricture with associated serosal tear, but no full-thickness injury was identified. An extended left hemicolectomy and end transverse colostomy was performed resulting in improvement in the patient’s clinical status and eventual discharge to subacute rehab.

  • gastrointestinal surgery
  • general surgery

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Footnotes

  • Twitter @kwestfall23

  • Contributors KW: Primary author of the manuscript. RB: Assisted with write-up and editing of the manuscript. MC: Primary investigator of this project and contributed to editing the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer-reviewed.

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