Abstract
A 61-year-old woman hospitalized for schizophrenia consulted our hospital because of aggravation of abdominal pain lasting for 3 days. Blood analysis revealed severe leukocytosis and an elevated level of CRP. Contrast-enhanced abdominal CT scan showed marked dilatation of the transverse colon. Volvulus of the transverse colon was suspected. Since we judged that the medical repositioning might entail a high risk of inducing perforation, we performed an emergency surgery. Operative findings included that the transverse colon showed necrotic changes for almost full length and moderate amount of hemorrhagic ascites was accumulated. We performed transverse colectomy and functional end to end stapled anastomosis. Postoperative progress was good, and she was transferred to the psychiatric hospital 10 days after the operation. Colonic volvulus accounts for approximately 3% of all colorectal mechanical obstructions. Moreover transverse colonic volvulus is rare, because 90% of colonic volvuli affect the sigmoid colon. In our case, transverse colonic volvulus developed in this patient during hospitalization for schizophrenia. Since she had been suffering from chronic constipation due to administration of plural psychotropic drugs, bowel motility disorder was considered to be an onset factor of colonic volvulus. Fortunately postoperative progress was good by colectomy and primary reconstructive surgery in our case. It is important for this disease to choice the appropriate therapeutics based on etiology. We report a case of transverse colonic volvulus with schizophrenia with a review of the literature.
