“TRANSVERSE COLON VOLVULUS IN THE SETTING OF A GIANT HIATAL HERNIA: AN UNUSUAL CASE REPORT” drfernandoolveracg@gmail.com

 

“TRANSVERSE COLON VOLVULUS IN THE SETTING OF A GIANT HIATAL HERNIA: AN UNUSUAL CASE REPORT”

4

Mexico

Oral or Poster

Transverse colon volvulus is an extremely rare cause of large bowel obstruction, representing less than 5% of colonic volvulus cases and with only about 100 cases reported worldwide. It carries a mortality of up to 30–33%, largely related to diagnostic delay. Giant type IV hiatal hernias may contain the stomach and other abdominal organs, increasing colonic mobility and predisposing to torsion. This case illustrates transverse colon volvulus associated with a giant hiatal/diaphragmatic hernia.

A 38-year-old female without significant comorbidities presented with 5 days of progressive epigastric abdominal pain (10/10), absence of bowel movements and oral intolerance. Examination showed generalized pain with peritoneal signs; labs demonstrated leukocytosis (18,000), neutrophilia (89%), elevated CRP (23 mg/L) and procalcitonin (8 ng/mL). CT revealed a markedly dilated transverse colon (up to 9 cm) with volvulus and a giant hiatal/diaphragmatic hernia

Exploratory midline laparotomy confirmed transverse colon volvulus and a diaphragmatic hernia containing the entire greater omentum. The herniated content was reduced and the defect closed with interrupted 1-0 Prolene. A 30 cm ischemic segment of transverse colon was resected and a side-to-side, antiperistaltic mechanical anastomosis performed; the remaining bowel was viable. The patient followed an ERAS protocol, with an uneventful recovery.

Transverse colon volvulus should be considered in large bowel obstruction, particularly in patients with major anatomical abnormalities such as giant type IV hiatal hernias. These defects may create excessive colonic mobility and favor torsion. Prompt recognition with cross-sectional imaging and timely surgery are essential to prevent ischemia, perforation and death.