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Volvulus of the splenic flexure is very rare cause of
colonic obstruction constituting 2% of cases of colonic
segmental volvulus. Primary splenic flexure volvulus
(SFV) is due to congenital absence or laxity of the
phrenocolic, gastro colic, and splenocolic ligaments
while secondary volvulus is due to other causes
including some prior surgery relea...
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Citations
... The management of SFV is almost the same as sigmoid colon volvulus, which consists of emergent surgery in case of clinical signs and symptoms of peritonitis after adequate resuscitation. In the time of emergent surgery, primary anastomosis should be avoided if gangrenous, perforated bowel, or peritoneal soiling is present [15]. In such cases, exteriorization of the proximal and distal colon in the form of an end colostomy and mucous fistula is advised. ...
Introduction
Splenic flexure volvulus (SFV) occurs as a result of twisting or torsion of a redundant colon around its mesentery. The SFV can be divided into primary and secondary types.
Presentation of case
An 82-year-old woman with a previous history of Parkinson's disease, diabetes mellitus and hypertension presented with a primary complaimt of obstipation and progressive abdominal pain. Abdomen was grossly distended and tympanic with generalized tenderness. The rectum was empty on digital rectal examination. Complete blood count showed leuckocytosis and neutrophlia. Plain abdominal X-rays showed distented cecum and ascending colon without any air in the gut distal to the splenic flexure. Regarding her unstable condition even aftre fluid resuscitation, she was transferred to the operating room. SFV was found and the standard left hemicolectomy was performed and bowel continiuity was established with primary anastomis of remained colonic ends. Postoperative period was uneventfull.
Discussion
The splenic flexure is strictly attached to the adjacent organs so its volvulus is rare. Most cases of adult SFV have an underlying disease associated with chronic constipation. Diagnosis of volvulus is suspected based on the history, clinical exam, and imaging. The initial and urgent treatment of SFV, if there are no signs of ischemia or perforation, may be conservative with endoscopic detorsion. Gangrenous bowel should not be detorted and should be resected with primary anastomosis or a diverting stoma.
Conclusion
SFV should be considered as a possible diagnosis of chronic constipation which might be diagnosed with plain abdominal Xray in non emergent condition. Special attention should be given to the medication history of the patient as the anticholinergic agents propagate normal pristaltis.
... A CT or contrast enema is usually needed to establish the diagnosis. Findings will include marked distension of the distal transverse colon, with a whirl sign in the region of the splenic flexure (57,58). ...
Large-bowel obstruction is an abdominal emergency with high morbidity and mortality rates if left untreated. Although abdominal radiography is usually the initial imaging study performed in patients suspected of having large-bowel obstruction, it may not be sufficient to distinguish obstruction from other causes of colonic dilatation. Computed tomography is the imaging method of choice as it can establish the diagnosis and cause of large-bowel obstruction. A contrast agent enema may be used to confirm or exclude large-bowel obstruction. In this review, the imaging findings in multiple causes of large-bowel obstruction are illustrated and compared with acute colonic pseudo-obstruction. (©) RSNA, 2015.
... Splenic fl exure volvulus (SFV) is very rare cause of colonic obstruction, constituting 1-2 % of colonic volvulus. Very few cases have been reported in the literature (1)(2)(3). Mortality rate of the SFV cases is low (1,4). In this paper, a 20-year-old male (soldier) case, who had died from generalized peritonitis caused by gangrenous SFV was presented and discussed with the literature data. ...
... Machado et al (2009) presented a case of SFV in a young man who had acute abdominal pain, and distension, and illustrated the usefulness of CT scan, and plain x-ray of the abdomen in making a preoperative diagnosis. They told that, laparotomy had revealed a gangrenous SFV, which had been resected and primary anastomosis had been carried out (2). Rath et al (2003) reported a case of a young female who had primary SFV due to absence of ligamental attachment. ...
The definition of volvulus is an axial twist of a portion of the gastrointestinal tract along its mesentery. The involved bowel is obstructed partially or completely with a variable degree of arterial and venous occlusion. The colon is the most common site for volvulus. The splenic flexure is the least common site of colonic volvulus. Splenic flexure volvulus (SFV) is a very rare cause of colonic obstruction, constituting 1-2 % of colonic volvulus. Mortality rate of the SFV cases is low.
We experienced a SFV case who was a 20-year-old male soldier. The case had come to the state hospital with complaints of severe left abdominal and lumbar pain and a medical history of relapsing urinary infection and nephrolithiasis. The doctor had hospitalized him with the diagnosis of paralytic ileus caused by nephrolithiasis. He had died after 14 hours and 35 minutes from hospitalization. Autopsy findings showed out that the death cause was generalized peritonitis due to gangrenous SFV.
In this paper, we presented this case and discussed its properties in the light of the literature data (Fig. 2, Ref. 7).
Radiotherapy is a method commonly used in thetreatment of head and neck malignancies. Oneof the most common side-effects of radiotherapyis oral mucositis, a toxic and dose and treatmentlimiting complication of radiotherapy, and the mostsignificant cause of morbidity in patients undergoingchemoradiation for head and neck cancers. 1 Studieshave shown that Iranian propolis contains a significantamount of flavonoids and phenolic compounds. 2In a recent study, Iranian propolis, used to treatradiation-induced mucositis, was found to postponethe appearance of lesions and substantially reducethe severity of mucositis. 3 The aim of this study wasto evaluate different doses of propolis on radiationinduced mucositis in rats and investigate the effectivedose of Iranian propolis for reducing radiation-inducedmucositis.
