Pelvic colon volvulus: Results of one-stage versus two-stage colectomy at the University Hospital of Conakry

Introduction: The aim of this study was to evaluate the results of one-stage colectomy versus two-stage colectomy at Conakry University Hospital. Methods: This was a retrospective study conducted at the University Hospital of Conakry from January 1, 2015 to December 31, 2019. All patients hospitalized and operated on in the Ignace Deen General Surgery and Donka Visceral Surgery departments for pelvic colon volvulus (PCV) who underwent colectomy during the study period were included. Results: We collected 87 cases of pelvic colon volvulus (PCV). The average age was 45.71 years with extremes of 5 years and 80 years with a male predominance of 82.83% and a sex ratio of 5.18. The morbidity was marked by 2 cases of anastomotic fistulas, 7 cases of parietal suppuration and 1 case of peristomal hemorrhage. 4 cases of death were noted in two-stage colectomy and 2 cases in one-stage colectomy. Conclusion: The occurrence of morbidity and mortality was not related to the type of colectomy. As our study does not allow us to affirm the superiority of one technique over the other, we recommend considering a future dynamic study that would take into account a larger sample.

UNUSUAL PRESENTATION OF ACUTE INTESTINAL OBSTRUCTION DUE TO TRANSVERSE COLON VOLVULUS IN LATE PREGNANCY

Transverse colon volvulus is the rarest type of colonic volvulus, with a higher morbidity and mortality rate. In pregnancy, intestinal obstruction due to transverse colon volvulus is rare and seldom reported, and its timely diagnosis can be difficult. We report an unusual case of transverse colon volvulus in a young female at late-term pregnancy. A 28-years-old, pregnant woman, gravida 2, para 1, at 34 weeks of gestation, presented with progressive abdominal pain and distention, commencing about 12 hours prior to admission, associated with vomiting and obstipation. Vital signs were stable. However, the abdomen was asymmetrically hugely distended. The initial abdominal ultrasound showed a single viable intrauterine fetus and dilated loops of bowels. As fetal distress progressed throughout the admission, a laparotomy was performed, which revealed an unexpected transverse colonic volvulus. Resection of the twisted segment and primary anastomosis were performed, followed by a cesarean section to deliver the baby. The mother made a satisfactory recovery. Although this patient’s preoperative clinical findings suggested colonic obstruction, the diagnosis of transverse colonic volvulus was only made intraoperatively and has seldom been previously described. Chronic constipation, the enlarging uterus, and the anatomical redundancy of the transverse colon may have been contributing factors. Transverse colon volvulus in late pregnancy is uncommon. Early diagnosis and prompt surgical intervention can significantly minimize maternal and fetal mortality.

Expression of Proteinase-Activated Receptor 2 During Colon Volvulus in the Horse

Large colon volvulus in horses is associated with a poor prognosis, especially when ischemic-reperfusion injury of the affected intestinal tract develops. Proteinase-activated receptor 2 (PAR2) plays an important role in the pathogenesis of inflammation in the gastrointestinal tract. The aim of this study was to evaluate the distribution and expression of PAR2 in colonic pelvic flexure of horses spontaneously affected by large colon volvulus (CVH group). Eight horses admitted for severe abdominal colon volvolus and which underwent surgery were included. Colon samples were collected after enterotomy. Data previously obtained from healthy horses were used as a control group. Histologic evaluation was carried out to grade the severity of the colon lesions. Immunofluorescence, western blot and quantitative polymerase chain reaction (RT-qPCR) were carried out on colon samples to evaluate PAR2 expression. In addition, the transcriptional profile of cytokines and chemokines was evaluated using RT2 Profiler™ PCR Array Horse Cytokines & Chemokines. Three out of the eight patients were euthanised due to clinical deterioration. Immunostaining for PAR2 was observed in the enterocytes, intestinal glands and neurons of the submucosal and myenteric plexi. In the CVH horses, the expression of PAR2 mesenger RNA (mRNA) did not differ significantly from that of the healthy animals; western blots of the mucosa of the colon tracts showed a clear band of the expected molecular weight for PAR2 (~44 kDa) and a band smaller than the expected molecular weight for PAR2 (25kDa), suggesting its activation. The gene expressions for C-X-C motif ligand 1 (CXCL1); interleukin 8 (IL8), macrophage inflammatory protein 2 beta (MIP-2BETA) were upregulated in the colic horses as compared with the colons of the healthy horses. Therefore, in the present study, the expression and activation of PAR2 in the colons of horses in the presence of an inflammatory reaction like that occurring in those with spontaneous colon volvulus was confirmed.