A Case of Proximal Colon Bowel Volvulus after Low Anterior Resection for Rectal Cancer

Colonic volvulus is responsible for 4–5% of all cases of intestinal  obstruction and most often found in the sigmoid colon, in elderly  patients with chronic constipation, where patients develop a large  redundant sigmoid colon and with a violation of diet. Twisting and  compression of mesenteric blood vessels leads to disruption of  intestinal wall nutrition followed by necrosis. Most cases of volvulus  require the surgical treatment. Abdominal radiography (barium  enema, MSCT) is frequently obtained as the initial diagnostic  imaging and has characteristic appearances. We present a case of  MRI diagnosis of the colon volvulus after the closure of the  transverse loop colostomy after low anterior resection for rectal  cancer. The cause of the volvulus was the twisting of the mobilized  part of colon with the mesentery when it was lowered into the pelvis. The protective transverse loop colostomy caused the absence of  clinical manifestations. After its closure patient was present the  clinical features of bowel obstruction and the appearance of MR  symptoms typical for this pathology. A retrospective analysis of MR  tomograms obtained before the closure of the transverse loop  colostomy, allowed revealing of signs of its subclinical ischemia. This  case demonstrates the possibilities of MRI in identifying both the  typical symptoms of colon volvulus and the signs indicating the possibility of colon twisting in patients after low anterior rectal resection, examined before closing the transverse loop colostomy.

1. Ha H.K., Kim S.K., Chun C.S., Kim I.C., Lee H.K., Shinn K.S., Bahk Y.W. CT analysis of intestinal obstruction due to adhesions: early detection of strangulation. J. Comput. Assist. Tomogr. 1993; 17 (3): 386–389.

2. Schima W. Bowel Obstruction – Diagnostic Algorithm and Differential Diagnosis. Medical Visualization. 2004; 1:78–87. (In Russian)

3. Kozlova Yu.A., Mumladze R.B., Olimpiev M. Yu. The role of computed tomography in the diagnosis of bowel obstruction. Annaly Khirurgii. 2013; 4: 5–11. (In Russian)

4. Berritto D., Iacobellis F., Mazzei M.A., Volterrani L, Guglielmi G, Brunese L, Grassi R. MDCT in ischaemic colitis: how to define the aetiology and acute, subacute and chronic phase of damage in the emergency setting. Br. J. Radiol. 2016; 89 (1061): 20150821. DOI:10.1259/bjr.20150821.

5. Kaprin A.D., Galkin V.N., Zhavorokov L.P., Ivanov V.K., Ivanov S.A., Romanko Yu. S. Symthesis of basic and applied research is the basis of obtaining high-quility findings and translating them into clinical practice. Radiatsiya i risk. 2017; 26: 26–40. (In Russian)

6. Rodimov S.V., Hubezov D.A., Puchkov D.K., Hubezov L.D., Ignatov I.S. Choice of preventive stoma for low colorectal anastomosis. Modern problems of science and education.2016; 5. URL: https://www.science-education.ru/ru/article/view?id=25111 (In Russian)

7. Zheng J., Feng X., Yang Z., Hu W., Luo Y., Li Y. The comprehensive therapeutic effects of rectal surgery are better in laparoscopy: a systematic review and metaanalysis. Oncotarget. 2017; 8 (8): 12717–12729. DOI: 10.18632/oncotarget.14215.

8. Park E.J., Baik S.H., Kang J., Hur H., Min B.S., Lee K.Y., Kim N.K. The impact of postoperative complications on long-term oncologic outcomes after laparoscopic low anterior resection for rectal cancer. Medicine (Baltimore). 2016; 95(14): e3271. DOI: 10.1097/MD.0000000000003271.

9. Hüser N., Michalski C.W., Erkan M., Schuster T., Rosenberg R., Kleeff J., Friess H. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann. Surg. 2008; 248 (1): 52– 60. DOI: 10.1097/SLA.0b013e318176bf65.

10. Ulrich A.B., Seiler C., Rahbari N., Weitz J., Büchler M.W. Diverting stoma after low anterior resection: more arguments in favor. Dis. Colon Rectum. 2009; 52 (3): 412–418. DOI: 10.1007/DCR.0b013e318197e1b1.

11. Tsarkov P.V., Kravchenko A.Yu., Tulina I.A., Tsugulya P.B. Does stapled colorectal anastomosis in anterior resection always guarantee restoration of intestinal continuity? The Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2012; 4: 73–80. (In Russian)

12. Kochatkov A.V., Negardinov A.Z., Lyadov V.K. Closure of ileostomy: 48 hours of hospitalization. Koloproktologia. 2015; 4: 24–27. (In Russian)

13. Gastrointestinal radiology: a pattern approach. 4th ed. Ed. R. Eisenberg. Philadelphia: Lippincott, 2002: 735–737.

14. Vandendries C., Julles M.C., Boulay-coletta I., Loriau J., Zins M. Diagnosis of colonic volvulus: findings on multidetector CT with three-dimensional reconstructions. Br. J. Radiol. 2010; 83 (995): 983–990. DOI: 10.1259/bjr/35714052.

15. Martin M.J., Steele S.R. Twists and turns: a practical approach to volvulus and instussusception. Scand. J. Surg. 2010; 99: 93–102.

16. Levsky J.M., Den E.I., DuBrow R.A., Wolf E.L., Rozenblit A.M. CT Findings of Sigmoid Volvulus. Am. J. Roentgenol. 2010; 194 (1): 136–143. DOI: 10.2214/AJR.09.2580.

17. Palmucci S., Lanza M.L., Gulino F., Scilletta B., Ettorre G.C. Diagnosis of a sigmoid volvulus in pregnancy: ultrasonography and magnetic resonance imaging findings. J. Radiol. Case Rep. 2014; 8 (2): 54–62. DOI: 10.3941/jrcr.v8i2.1766.

18. Fisher J.K. Computed tomographic diagnosis of volvulus in intestinal malrotation. Radiology. 1981; 140: 145–146.

19. Odaryuk T.S., Vorobyev G.I., Shelygin Yu.A. Surgery for rectal cancer. M.: Dedalus, 2005. 256 p. (In Russian)