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

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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): .

Copyright

Copyright: © 2020 Pawel Ajawin., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.