Volvulus of the ascending and transverse colon in a 4-year-old child: a case report

The incidence of colonic volvulus in the pediatric population is unknown, with literature limited to case reports and small case series. Volvulus of the transverse colon is very rare and only a few cases have been documented so far. A 4-year-old boy with no medical or surgical history who was brought to the emergency department due to acute abdominal pain and vomiting. Physical exam revealed a distended and tender abdomen, mostly in the epigastrium and right side. Basic blood tests were not revealing. A plain abdominal x-ray was done and appeared normal. A subsequent computed tomography (CT) scan showed a largely distended colon and a whirl sign in the mesocolon, suspicious for a colonic volvulus. He was taken to the operating room for an emergency laparotomy during which we found that the ascending and the transverse colon had volvulized 360° in an anticlockwise direction. The volvulized colon had no signs of ischemia. We detorsed the colon and confirmed that the perfusion was completely normal. The patient had an uneventful initial recovery. However, 48 hours after the operation he developed acute abdominal pain, which prompted us to take him back to the operating room for a re-laparotomy. We found that the segment of colon that had initially volvulized, despite not being ischemic at the time of the first operation, was now severely ischemic. We decided to do a resection of the ischemic segment and followed with an end-to-end anastomosis. The patient had an uneventful recovery and was discharged home on the fourth postoperative day. The pathology of the resected segment was unremarkable. At six months of follow-up, he remains in good health. Transverse colonic volvulus, though rare in children, should be considered in children who develop acute abdominal pain and vomiting, even in the absence of abnormal findings on the plain abdominal films. Close postoperative monitoring is crucial for detecting potential early complications.