LAUSR

An urgent surgical referral was made for a middle-aged gentleman with a 1-day history of abdominal pain and significant past history of endovascular repair for Stanford A aortic dissection, cerebrovascular accidents and atrial fibrillation on warfarin. Examination revealed a distended abdomen with epigastric tenderness but no peritonism. Laboratory investigations were as follows: full blood count demonstrating a haemoglobin of 7.7 g/ dL and elevated white cell count of 21.1 × 10^9/L, international normalized ratio (INR) of 2.9, blood gas analysis showing base excess of − 8 mmol/L and lactate of 5.7 mmol/L. A contrasted computed tomography (CT) scan revealed a loop of dilated large bowel in a Ushaped configuration (Fig. 1). An axial cut tracing the abnormal path of the middle colic artery suggests transverse colon volvulus (TCV). Grossly dilated transverse colon with an associated mesenteric hematoma was seen intraoperatively (Fig. 3). The patient underwent transverse colectomy and temporary closure in view of intraoperative instability. Relook laparotomy, right hemicolectomy and ileo-colic anastomosis was performed 36 h later. Postoperative recovery was uneventful and the patient was discharged well 8 days after surgery.