Synchronous volvulus of the transverse and sigmoid colon: a rare case of large bowel obstruction.

Colonic volvulus usually occurs as a single event that can affect various parts of the colon. The usual sites affected being the sigmoid colon (75%) and the caecum (22%). The phenomenon of multiple sites simultaneously undergoing volvulus is an extremely rare occurrence. We report a rare case of simultaneous sigmoid and transverse colon volvulus in a 52-year-old female. The clinical presentation and the radiological findings were that of large bowel obstruction. A subtotal colectomy and colocolic anastomosis were performed and the postoperative period was uneventful. Though rare the development of transverse and sigmoid volvulus in the same patient must always be considered in the differential diagnosis, when dealing with recurrent intermittent abdominal pain or acute intestinal obstruction.

Ileosigmoid knot in a patient with Down syndrome: a unique surgical emergency.

The ileosigmoid knot (ISK) or double ileosigmoid volvulus is a wrapping of the small intestine around the base of the sigmoid colon. We report an unusual case in the digestive surgery department of the Ibn Tofail Hospital of CHU Mohammed VI Marrakech of a 28-year-old man with Down's syndrome who presented with symptoms and signs of intestinal obstruction. Abdominal CT scan revealed a whirl sing and significant distension of the sigmoid loop. Exploratory laparotomy revealed ISK resulting in gangrene of ileum and sigmoid colon. The surgical procedure was a necrotic digestive segments resection, with a double-barrelled ileostomy and a Hartmann procedure. One month afterwards, the patient was operated on to reestablish of the continuity. Through this observation and a review of the literature we define the diagnostic, therapeutic and prognosis aspects of this rare clinical entity.