S3683 Successful Endoscopic Decompression of Transverse Colon Volvulus Case Report

Introduction: Transverse colon volvulus accounts for 4% of colon volvulus presentation. Patients usually require emergent surgical intervention. We present a case of successful endoscopic decompression of transverse colon volvulus. Case Description/Methods: A 27-year-old woman with a history of Coffin-Siris syndrome, gastric ulcer, severe intellectual disabilities, seizure disorder, transferred from Children’s Home Center for evaluation of a 2-day history of progressive abdominal distension and lack of Bowel movements associated with increased burping with G tube usage. Abdominal examination showed severe distension of the abdomen and firm to palpation with demonstration of pain behavior upon examination. Vitals were stable. Labs were pertinent for mild leukocytosis without any evidence of electrolyte abnormalities. Computed tomography (CT) Abdomen and Pelvis with Contrast showed acute large bowel obstruction secondary to volvulus of the distal transverse colon. Mesenteric edema of the transverse and descending colon was suspicious for impending bowel compromise. Surgical consultation was obtained. The patient’s family opted for an endoscopic attempt to decompress the volvulus. Flexible sigmoidoscopy subsequently identified Transverse colon volvulus, with viable appearing mucosa in the distal transverse colon. Decompression of the volvulus was attempted with success. A colon decompression tube was placed. Abdominal distension immediately improved. Family deferred the surgical approach, and the patient was discharged in stable condition. Discussion: Transverse colon volvulus is a rare cause of acute abdomen. Hepatic and splenic flexure fixation along with short meso-colon prevents transverse colon volvulus. If patients are hemodynamically stable without vascular compromise, then endoscopic evaluation can be attempted. If endoscopic decompression is unsuccessful, then a surgical approach is recommended.