J Korean Soc Radiol. 2010 Apr;62(4):369-372. Korean.
Published online Apr 30, 2010.
Copyright © 2010 The Korean Society of Radiology
Case Report

Total Colonic Volvulus Followed by Mesenteroaxial Gastric Volvulus in a 24-year-old Female: A Case Report

Mi Kyung Kim, M.D., Jong Beum Lee, M.D., Gihyeon Kim, M.D., Hwa Yeon Lee, M.D., Yang Soo Kim, M.D. and In Sup Song, M.D.
    • 1Department of Radiology, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Korea.
Received October 19, 2009; Accepted November 04, 2009.

Abstract

A very rare case of multi-organ volvulus, serially involving the spleen, colon and stomach, is presented in a 24-year-old female patient with Down syndrome. This case is of interest because of the three different types of volvulus or torsion that occurred serially over thirteen years in the same patient. We report the imaging findings and suggest possible pathogenesis by a review of the operation record and literature.

Keywords
Stomach; Colon; Spleen Disesases; Stomach Volvulus; Torsion, Abnormality

Figures

Fig. 1
A. Supine simple abdomen shows markedly gaseous distension of the colon. Subsequent CT showed this was whole colon except the part of rectosigmoid colon. Air filled appendix is shown (arrow).
B-D. Contrast-enhanced axial CT scans. B. At the level of the liver dome, CT scan shows displaced stomach on right side of the liver and markedly distended colon with poorly enhanced wall. C. At the level of SMA origin, CT scan shows markedly distended colon with poorly enhanced wall. Note gas distended appendix on the right side. D. At the level 2 cm below C, CT scan shows totally obliterated SMA (arrow).

E. Erect simple abdomen shows severely distended stomach with air-fluid level.

F. Coronal reformatted CT reveals that the esophagogastric junction (short arrow) is below the pylorus (long arrows). The CT was undertaken after emergent gastric decompression through the nasogastric tube. Note the nasogastric tube within the esophagogastric junction.

References

    1. Lehance CW, Gold DM. Colonic volvulus - an old problem with a new twist. Colorectal Dis 2009;11:882–883.
    1. Learmonth JR. Elongation and dilatation of the colon. Br Med J 1937;2:154–156.
    1. Bakir B, Poyanli A, Yekeler E, Acunas G. Acute torsion of a wandering spleen: imaging findings. Abdom Imaging 2004;29:707–709.
    1. Herman TE, Siegel MJ. CT of acute splenic torsion in children with wandering spleen. AJR Am J Roentgenol 1991;156:151–153.
    1. Berrocal T, Lamas M, Gutieerrez J, Torres I, Prieto C, del Hoyo ML. Congenital anomalies of the small intestine, colon, and rectum. Radiographics 1999;19:1219–1236.
    1. Cherukupalli C, Khaneja S, Bankulla P, Schein M. CT diagnosis of acute gastric vovulus. Dig Surg 2003;20:497–499.
    1. Kotobi H, Auber F, Otta E, Meyer N, Audry G, Helardot PG. Acute mesenteroaxial gastric volvulus and congenital diaphragmatic hernia. Pediatr Surg Int 2005;21:674–676.

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