case_images: PMC10467330_01
case_images: Patient's abdominal distention.
case_images: 10.1177_2050313X231197001-fig1.jpg
case_images: PMC10467330_01_10.1177_2050313X231197001-fig1.jpg
case_images: fig1-2050313X231197001
case_images: On the abdominal examination, He had severe and progressive abdominal distention, as can be seen in Figure 1 and abdominal tenderness with a predominance of the left upper quadrant, which spread to his back and left shoulder.
case_images: Upright chest X-ray.
case_images: 10.1177_2050313X231197001-fig2.jpg
case_images: PMC10467330_01_10.1177_2050313X231197001-fig2.jpg
case_images: fig2-2050313X231197001
case_images: Upright chest X-ray revealed nothing, as can be seen in Figure 2, but air-fluid level and dilated bowel loops were seen in upright and supine abdominal X-rays as can be seen in Figures 3 and 4.
case_images: Upright abdominal X-ray: Red arrows show air-fluid level.
case_images: 10.1177_2050313X231197001-fig3.jpg
case_images: PMC10467330_01_10.1177_2050313X231197001-fig3.jpg
case_images: fig3-2050313X231197001
case_images: Upright chest X-ray revealed nothing, as can be seen in Figure 2, but air-fluid level and dilated bowel loops were seen in upright and supine abdominal X-rays as can be seen in Figures 3 and 4.
case_images: Supine abdominal X-ray: Red arrows show dilated bowel loops.
case_images: 10.1177_2050313X231197001-fig4.jpg
case_images: PMC10467330_01_10.1177_2050313X231197001-fig4.jpg
case_images: fig4-2050313X231197001
case_images: Upright chest X-ray revealed nothing, as can be seen in Figure 2, but air-fluid level and dilated bowel loops were seen in upright and supine abdominal X-rays as can be seen in Figures 3 and 4.
case_images: Abdominal CT scan: Red arrows show dilated loops.
case_images: 10.1177_2050313X231197001-fig5.jpg
case_images: PMC10467330_01_10.1177_2050313X231197001-fig5.jpg
case_images: fig5-2050313X231197001
case_images: So, the patient asked to do abdominal CT scan for more investigation with suspicion of colon obstruction, and the result confirmed dilated bowel loops, as can be seen in Figure 5, and the probability of obstruction and volvulus.
case_images: Transverse colon volvulus: Green arrow shows the location of volvulus.
case_images: 10.1177_2050313X231197001-fig6.jpg
case_images: PMC10467330_01_10.1177_2050313X231197001-fig6.jpg
case_images: fig6-2050313X231197001
case_images: But due to severe ilium wall inflammation, edema, and increased thickness of the wall, and due to low blood pressure (BP = 90/67 mmHg), total colectomy (Figures 6 and 7) and end ileostomy were created instead of ileorectal anastomosis.
case_images: Colon after total colectomy.
case_images: 10.1177_2050313X231197001-fig7.jpg
case_images: PMC10467330_01_10.1177_2050313X231197001-fig7.jpg
case_images: fig7-2050313X231197001
case_images: But due to severe ilium wall inflammation, edema, and increased thickness of the wall, and due to low blood pressure (BP = 90/67 mmHg), total colectomy (Figures 6 and 7) and end ileostomy were created instead of ileorectal anastomosis.