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A Unique Case of Recurrent Metachronous Volvulus of the Gastrointestinal Tract

Dimitrios V. Avgerinos, MD; Omar H. Llaguna, MD; Richard L. Friedman, MD
Arch Surg. 2009;144(12):1176-1178. doi:10.1001/archsurg.2009.206.
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Colonic volvulus is an uncommon disease that predisposes patients to bowel obstruction in both the adult and pediatric population. The international literature offers few reports of synchronous or metachronous volvulus of 2 organs of the gastrointestinal tract. We describe a unique case of a patient who presented with recurrent metachronous volvulus of the sigmoid colon, cecum, and stomach. The patient underwent multiple operations for bowel obstruction, lysis of adhesions, and colon resection. The interesting intraoperative findings were a very long mesentery and peritoneal attachments of the intraabdominal gastrointestinal organs that made the stomach and colon extremely mobile and thus susceptible to volvulus. Prophylactic pexis of the cecum and the stomach during the first operation, in light of the elongated mesentery, may have prevented the subsequent episodes of volvulus.

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Figure 1.

Computed tomography of abdomen with oral contrast showing massive dilatation of the colon owing to sigmoid volvulus.

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Figure 2.

Abdominal image showing right colon and cecal volvulus.

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