Transverse-sigmoid Colon Knot: a Rare Cause of Bowel Obstruction

Case Report: A 63year old lady was admitted to hospital with a 3day history of lower abdominal pain and obstipation. On examination, she demonstrated a distended tender abdomen. Digital examination revealed faecal impaction of the rectum. Blood investigations were normal and abdominal X-ray revealed dilated large bowel loops with some faecal loading. Initially managed conservatively, she proceeded for a CT abdomen and pelvis to ascertain the cause of obstruction. This revealed a very convoluted and faecally loaded large bowel, with two apparent areas of volvulus involving the midtransverse and sigmoid colon. There was no evidence of free fluid or free air. Without clinical improvement, she proceeded to an exploratory laparotomy which revealed a long and redundant sigmoid colon found to be looping around a very mobile and redundant transverse colon. The caecum, distal transverse and proximal sigmoid colon were grossly distended and loaded with faeces. The entire large bowel was carefully untwisted to relieve the apparent knot and all involved loops appeared congested but viable. No resection of bowel was required. The sigmoid colon and mobile left and right colon were fixed with Vicryl to the abdominal wall. A caecostomy was formed to allow the colon to remain decompressed. Post-operatively, the patient made an unremarkable recovery.