Acta Scientific Clinical Case Reports

Case Report Volume 1 Issue 11

Total Colectomy in a Gangrenous Large Bowel Obstruction Secondary to Double Closed Loop Obstruction

Pawel Ajawin*, Khalid Abdela, Hunde Garoma, Giel Samuel, Desalegn Tadese

Department of General Surgery, Adama Hospital Medical College, Adama, Ethiopia

*Corresponding Author: Pawel Ajawin, Department of General Surgery, Adama Hospital Medical College, Adama, Ethiopia.

Received: February 24, 2020; Published: November , 2020

×

Abstract

Introduction: Closed loop obstruction is commonly encountered in sigmoid volvulus. When it’s become gangrenous it’s called necrotizing colitis, Gangrene of the whole colon from the caecum to the sigmoid is very rare which need prompt early recognition and immediate surgical intervention to avoid catastrophic complications due to gangrenous bowel and peritonitis.

Presentation of the Case: 45 years old man who presented with large bowel obstruction of 24 hour duration, with a board like tender abdomen on palpation. with septic shock, his abdominal radiograph shows features of peripherally dilated bowel loops with classical coffee bean sign and minimal air fluid level centrally. On laparotomy, a gangrenous sigmoid due to volvulus was found along with complete gangrene of the proximal bowel from the ileocaecal junction till the volvulus distally. There is a possibility it could be due to a double closed loop obstruction, first at the sigmoid volvulus and the other one being between the competent ileocaecal valve and the proximal end of the volvulus. A total colectomy with an end ileostomy was performed.

Discussion: Gangrenous obstruction involving only the entire colon is very rare. Large bowel obstruction is a surgical emergency due to it's unpredictable progression s from simple to complicated one, beginning with fulminant ischemia leading to gangrene of the entire large bowel due to double closed loop obstruction secondary to presumably competent ileocaecal valve.

Conclusion: To our knowledge, such gangrene of the entire large bowel due to a sigmoid volvulus and a competent ileocaecal valve has not been reported in literature, there were a case report from India in 2015. Here we highlight the fact that, the rapid ischaemic changes that follow a closed loop obstruction. Therefore, early diagnosis and intervention is important for better outcome.

Keywords: Total Colectomy; Gangrenous Large Bowel; Closed Loop Obstruction; Sigmoid Volvulus

×

References

  1. D Weingrow., et al. “Delayed presentation of sigmoid volvulus in a young woman”. Western Journal of Emergency Medicine 13 (2012): 100-102.
  2. DB Hinshaw and R Carter. “Surgical management of acute volvulus of the sigmoid colon: a study of 55 cases”. Annuals of Surgery 146 (1957): 52-60.
  3. K Hirao., et al. “Sigmoid volvulus showing “a whirl sign” on CT”. Internal Medicine 45 (2006): 331-332.
  4. Farinella Cirocchi., et al. “The sigmoid volvulus: surgical timing and mortality for different clinical types”. World Journal of Emergency Surgery (2010): 1.
  5. WH Lewis (Ed.), Anatomy of the Human Body Henery Gray, 20th ed., Lea and Febiger, Philadelphia, (1918).
  6. D Kumar and SF Phillips. “The contribution of external ligamentous attachments to function of the ileocecal junction”. Diseases of the Colon and Rectum 30 (1987): 410-416.
  7. Kristine D Slam., et al. “LaPlace’s law revisited: cecal perforation as an unusual presentation of pancreatic carcinoma”. World Journal of Surgical Oncology (2007): 5-14.
  8. LC El-Amin., et al. “Ileocecal valve: spectrum of normal findings at double-contrast barium enema examination”. Radiology 227 (2003) 52-58.
  9. HK Chang., et al. “Obstructive colitis proximal to obstructive colorectal carcinoma”. Asian Journal of Surgery 1 (2009): 26-32.
  10. MH Tsai., et al. “Obstructive colitis proximal to partially obstructive colonic carcinoma: a case report and review of the literature”. International Journal of Colorectal Disease3 (2004): 268-272.
  11. Zheng Lou., et al. “Appropriate treatment of acute sigmoid volvulus in the emergency setting”. World Gastroenterology 19 (2013): 4979-4983.
  12. WE Longo., et al. “Outcome of patients with total colonic ischemia”. Diseases of the Colon and Rectum 40 (1997): 1448-1454.
  13. E Senati and LD Coen. “Massive gangrene of the colon—a complication of fecal impaction”. Diseases of the Colon and Rectum 32 (1989): 146-148.
  14. Bhaskaran A Mohan. “A rare case report of colonic perforation and gangrene: a sequelae of self-inflicted transanal compressed air injury”. Euroasian Journal of Hepato-Gastroenterology2 (2013): 136-138.
  15. R Moldovanu., et al. “Total necrotizing colitis proximal to obstructive left colon cancer: case report and literature review”. Chirurgia 108 (2013): 396-399.
  16. Priyanka Akhilesh Sali., et al. “Total colectomy in a gangrenous large bowel due to a rare double closed loop obstruction”. Department of General Surgery, T.N Medical College and B.Y.L Hospital, Mumbai Central, Mumbai, Maharashtra, India (2015).
×

Citation

Citation: Pawel Ajawin., et al. “Total Colectomy in a Gangrenous Large Bowel Obstruction Secondary to Double Closed Loop Obstruction". Acta Scientific Clinical Case Reports 1.11 (2020): .




Metrics

Acceptance rate30%
Acceptance to publication20-30 days
Impact Factor1.278

Indexed In





News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is May 25, 2022.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of “Best Article of the Issue”.
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.
  • Contact US