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Intussusception in adults represents 1% of bowel obstructions and up to 0.02% of all hospital admissions. Amongst these, colo-colic intussusception of the descending colon forms the rarest of causes due to the fixed nature of the descending colon. Most of adult intussusceptions follow a lead point and are commonly due to colonic malignancy which may get missed on pre-operative evaluation. Surgery is usually warranted as these patients are usually symptomatic and at risk of vascular compromise, leading to perforations and obscure malignancies. We present a case of laparoscopic limited hemicolectomy and primary anastomosis in a middle-aged male who presented with colo-colic intussusception, which appeared to be following a malignant mass on imaging and lipoma on colonoscopic biopsy done twice. Keeping in mind the possibility of a malignant lead point, no attempt was made to reduce the intussusception and a vessel first approach with 5 cm margin on either side was performed.

Volvulus is the rotation or twisting of the intestine around its vascular pedicle. The occurrence of descending volvulus after sigmoidectomy is extremely rare. We report a case of a 35-year-old male who presented with abdominal distention, cramping, and no passage of feces or gas for three days. He had a history of recurrent sigmoid volvulus, previously treated with sigmoidectomy. On this occasion, clinical examination and imaging revealed a distended bowel with air-fluid levels. During exploratory laparotomy, descending colon volvulus, a rare finding, was confirmed. The patient underwent a left hemicolectomy and transverse stoma and recovered well postoperatively. Descending colon volvulus is a rare but serious complication after sigmoidectomy, and early diagnosis is essential. In volvulus-endemic regions, awareness of this condition is critical to prevent delayed diagnosis and complications. [ABSTRACT FROM AUTHOR]

Colorectal cancer is a common cancer with a large burden of disease. Adenocarcinomas account for majority of colorectal cancers, arising from glandular epithelium. Other malignancies including neuroendocrine, adenosquamous, spindle cell and squamous cell carcinomas (SCCs) are seldomly encountered. Primary colorectal SCC was first reported in 1919 and is particularly rare. It is difficult to manage as patients present late, with locally invasive or metastatic disease. We present the case of a woman in her 40s with a previously resected sigmoid adenocarcinoma and a new splenic flexure mass. Histopathology revealed an SCC without evidence of extra-colonic disease. The patient underwent resection with clear margins, however, did not tolerate systemic adjuvant treatment and developed local recurrence within twelve months. We add our patient's case to the small compilation of cases of primary colorectal SCC along with a summary of its clinical and histological characteristics, strategies in management and considerations for future research. [ABSTRACT FROM AUTHOR]

Gas gangrene is a rare, severe gas-producing infection that can be related to colorectal cancer. Gas gangrene can be confirmed by radiologic findings and crepitation on touch. Spontaneous gas gangrene can be associated with colorectal cancer. An 80-year-old female complaint about a sudden abdominal pain, accompanied with progressive swelling pain in thigh and fever. Diagnosis based on assessment findings were gas gangrene and descending colonic cancer perforation. Emergency surgery was performed for debridement and drainage, followed by vacuum sealing drainage (VSD) with polyurethane (PU). Two more surgical interventions were given before the colonic tumor surgery. The patient recovered well in the long-term follow-up. This report demonstrates the diagnosis, treatment, and management of a successful case of gas gangrene caused by perforation of descending colonic cancer. Accurate preoperative diagnosis and reasonable use of VSD (PU) material played an important role in the treatment of this case. [ABSTRACT FROM AUTHOR]

A defunctioning stoma is used to alleviate the consequences of anastomotic leakage after low anterior resection for rectal cancer. A loop ileostomy is often preferred but may lead to dehydration and kidney injury. Here, we present a case series for an alternative: the left-sided loop colostomy. A convenience sample of four patients underwent robotic low anterior resection for rectal cancer. A complete splenic flexure mobilization and a total mesorectal excision were performed. To defunction the anastomosis, the redundant left colon was brought up to a stoma site in the left iliac fossa and matured as a loop colostomy. Two patients experienced minor stoma leaks and one also had a small prolapse, while all patients had their colostomies reversed on average 7 months after surgery without complications. There were no dehydration episodes and creatinine levels remained within baseline levels at end of follow-up (on average 18 months). [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the endoscopic sensitivity for each segment of the colon. MATERIALS AND METHODS: Observational and retrospective study performed in the Laboratory of Histopathology and Molecular Biology of the Hospital Ángeles del Carmen, Guadalajara, Jalisco, Mexico, with the histopathological tests practiced from January 2018 to October 2021 in patients with colorectal biopsies, stained with hematoxylin and eosin and simultaneously analyzed by four specialists in pathological anatomy by light microscopy. For statistical analysis of the data, Statgraphics 18 software was used to determine the sensitivity of histopathologic examination of each colonic segment. RESULTS: Histopathologic studies of colorectal biopsies from 130 patients diagnosed with microscopic colitis were reviewed. By segment alone, the sigmoid colon had the highest sensitivity, followed by the ascending colon and the descending colon. Collagenous colitis was more common in men than in women; mixed lymphocytic and microscopic colitis were more common in women. The mean ages for collagenous colitis, lymphocytic colitis, and mixed microscopic colitis were 50.7 ± 21.8, 50.44 ± 17.6, and 49.2 ± 23.3 years, respectively. CONCLUSIONS: Due to the high frequency of mixed microscopic colitis, it is important to consider it a subtype of microscopic colitis in future studies. Contrary to previous reports, the results of this study show that collagenous colitis is more common in men than in women. [ABSTRACT FROM AUTHOR]

Environmental contamination and the resulting food contamination represent a serious problem and pose a major threat to animal and human health. The gastrointestinal tract is directly exposed to a variety of substances. One is glyphosate, whose presence in the soil is commonly observed. This study demonstrates the effects of low and high glyphosate doses on the populations of intramural neurons of the porcine descending colon. An analysis was performed on neurons ex-pressing the vasoactive intestinal peptide, pituitary adenylate cyclase-activating peptide, a neuronal isoform of nitrogen oxide synthase, and galanin. Even a low dose of glyphosate increased the number of neurons immunoreactive against the studied substances. However, the changes depended on both the plexus analysed and the substance tested. Meanwhile, a high glyphosate dose resulted in quantitative changes (an increase in the number) within neurons immunoreactive against all the studied neuropeptides/enzymes in the myenteric plexus and both submucosal plexuses. The response of the enteric nervous system in the form of an increase in the number of neurons immunoreactive against neuroprotective substances may suggest that glyphosate has a toxic effect on enteric neurons which attempt to increase their survivability through the released neuroprotective substances. [ABSTRACT FROM AUTHOR]

Background: More early the diagnosis of acute intestinal obstruction is made, more chances of success are there. At the same time, after diagnosis, appropriate management also decides the chances of success. Pathophysiological effects of the condition should be kept in mind while managing such cases. Objective: To study clinical profile of patients with acute intestinal obstruction. Methods: Prospective observational study was carried out among 90 cases of acute intestinal obstruction. Complete resuscitation of the patients was carried out. Once the patient was stable, surgical intervention was done in the indicated cases as per the standard operative guidelines. Throughout the postoperative period, the patients were monitored carefully in the postoperative intensive care units or wards depending on the patients' general condition and toxemia. Results: Incidence of acute intestinal obstruction was 25.7%. Incidence of intestinal obstruction was highest in >50 years (66.7%) cases. Hernia and Strictures (TB and non-TB) was more common in females than males. Incisional hernia was most common type in 64.3%. Descending colon, sigmoid, rectum was the most common site of carcinoma in 41.7%. Small bowel was involved more than large bowel for hernia, adhesions and band, strictures, mesenteric ischemia. But, carcinoma was almost three times more in large bowel compared to small bowel. Incidence of gangrene was 100% in case of mesenteric ischemia. Only 13 cases had postoperative complications. Most common complication was wound infection in six cases. Conclusion: Incidence of acute intestinal obstruction was 25.7%. incidence of complications was very less postoperatively. [ABSTRACT FROM AUTHOR]

Background: The colon has two different embryological origins, which is why it can be divided into right and left with different characteristics each one; therefore, neoplastic lesions have a different clinical picture and are also associated with different pathologies. Objective: To describe the clinical and histopathological characteristics of malignant colon tumors acording to their location. Material and methods: Descriptive, retrospective study with 94 patients diagnosed with colon cancer. Descriptive statistics were performed with the calculation of frequencies and percentages, and chi-squared tests were calculated. Results: Mean age was 61.3 years, 49 (52.1%) were women; 53 (56.4%) were left-sided and 41 (43.6%) right-sided. The main symptom was hematochezia in 32 (60.4%), in patients with left cancer; and diarrhea in 20 (48.8%), in patients with right-sided colon cancer. The presentation of stage I tumors and polyps, p = 0.044 and p = 0.043, respectively, was more frequent on the right side compared to the left side; in the left, hematochezia (p = 0.001), narrow stools (p = 0.05), and a history of type 2 diabetes mellitus (T2DM) (p = 0.036) were more frequent compared to the opposite site. Conclusions: Stage I and the presence of polyps were more frequent in right-sided cancer compared to left-sided cancer; T2DM, as well as hematochezia and narrow stools were more associated with the left side compared to the right side. [ABSTRACT FROM AUTHOR]

Ileosigmoidal knotting (ISK) is a rare, possibly fatal cause of intestinal obstruction. ISK is a compound volvulus that is more common in Africa and Asia. ISK is mostly seen in adults, pediatric cases reported in the literature are much rarer. In this report, we present the first reported case of ISK in a pediatric patient from Nepal. An 8-year-old male child presented with symptoms of abdominal pain, vomiting, and obstipation. The abdomen was distended with generalized tenderness. Erect abdominal X-ray showed multiple air-fluid levels. Intraoperatively, gangrenous ileum loops were entangled around the sigmoid, and resection of the gangrenous ileum and sigmoid was performed. An end-to-end colo-colic anastomosis from the descending colon to the remaining sigmoid with a double-loop ileostomy was performed. Pediatric ISK is a rare fatal form of intestinal obstruction that progresses quickly to gangrene. Clinical signs and symptoms are nonspecific, making preoperative diagnosis challenging. [ABSTRACT FROM AUTHOR]

Abstract Background Laparoscopic surgery for cancer located in the transverse colon or splenic flexure is difficult because of vascular variability in this region and adjacent vital organs such as the pancreas, spleen, and duodenum. Methods This retrospective cohort study involved 51 patients who underwent laparoscopic surgery for colon cancer at Tokushima University Hospital from July 2015 to December 2020. Variations of the middle colic artery (MCA), left colic artery (LCA), middle colic vein (MCV), and first jejunal vein (FJV) and short-term outcomes of laparoscopic surgery in patients with each vascular variation were evaluated. Results Variations of the MCA, LCA, MCV, and FJV were classified into four, three, five, and three patterns, respectively. The short-term outcomes of laparoscopic surgery for transverse colon cancer in patients with MCA variations and those with FJV variations were evaluated, and no significant difference was found in the operation time, blood loss, postoperative complication rate, time from surgery to start of dietary intake, or time from surgery to discharge among the different variations. Additionally, no significant differences were found in the short-term outcomes of laparoscopic surgery for descending colon cancer in patients with LCA variations. Conclusion Preoperative assessment of vascular variations may contribute to the stability of short-term outcomes of laparoscopic surgery for transverse colon, splenic flexure, and descending colon cancer.

Schwannomas of the gastrointestinal tract are rare spindle cell tumors that account for 2–6% of mesenchymal tumors. An elderly male was found to have a left colon mass on CT scan and colonoscopy with pathology of fibrotic tissue. A laparoscopic-assisted left hemi-colectomy with primary anastomosis was performed. Pathology demonstrated spindle cell neoplasm arranged in short fascicles that were strongly and diffusely positive for S100. An elderly female was found to have a submucosal lesion on surveillance colonoscopy in the proximal transverse colon. Biopsy with jumbo forceps revealed spindle cell neoplasm positive for S100. Patient underwent an uncomplicated limited non-oncologic segmental transverse colectomy. We report only the ninth case of left and sixth in the transverse colon described in the literature. As is true for other mesenchymal tumors, mucosal biopsy is usually inconclusive and deep biopsy or submucosal resection is required, making pre-operative surgical decision difficult. [ABSTRACT FROM AUTHOR]

Malignant colonic neuroendocrine tumours are rare. Even more uncommon is their occurrence in the left colon. They also infrequently occur in males and young adults. We describe a rare case of poorly differentiated neuroendocrine carcinoma of the descending colon in a 32-year-old male who presented with signs of intestinal obstruction. He later had exploratory laparotomy and tumour resection with 5 cm gross tumour margins and Hartman-type colostomy and completed six cycles of Etoposide and Carboplatin combination. He has been tumour- and symptom-free for 36 months. Even though rare, neuroendocrine tumours should be an important differential of all colonic tumours, irrespective of the patient's age and sex, and surgeons should have a high index of suspicion for them. Although they most commonly occur in the right colon (cecum), they can also be found in the descending colon, where they can present with intestinal obstruction. Tumour resection with 5 cm gross tumour margins and Hartman-type colostomy can be handy. Etoposide and Carboplatin combination can improve overall survival in complicated World Health Organization (WHO) stage 3 neuroendocrine carcinoma with regional lymph node involvement, and generally poor prognosis, but without evidence of distant metastasis, and relatively fair performance index. Younger patients with neuroendocrine carcinomas may benefit better from platinum-based chemotherapy., (Copyright © 2024 Nigerian Medical Association.)

Background: Colorectal cancer (CRC) is the most prevalent gastrointestinal (GI) cancer. With 5% risk of developing CRC in life, it became the third leading cause of cancer death in developed nations. In Nigeria, it is the most common GI cancer. However, there are limited data on CRC in the study area (North-Western part of Nigeria). The aim of this study was to identify the clinical, endoscopic and histological profile of CRC seen on colonoscopy. Methodology: This was a retrospective descriptive study where colonoscopic and histological records of suspected CRC in the study centre between January 2008 to December 2017 were evaluated. Results: Records of 135 patients were reviewed, and males constituted 63.7%. The mean age was 46.61 ± 16.80 years, with 30–39 years as a modal group. Common presentations were diarrhoea (86.7%) and bleeding per rectum (68.9%). Areas affected were rectosigmoid colon (63%), ascending colon (14.1%), descending colon (8.9%), transverse colon (7.4%) and anal canal (6.7%). Histologically, adenocarcinoma was reported in 57.8%, mucinous adenocarcinoma in 8.1% and signet ring cell adenocarcinoma in 3.7%. Tubular and villous adenomas were 3% each. Others were carcinoid tumours (1.5%), metastatic adenocarcinoma, squamous cell carcinoma, basal cell carcinoma, GI stromal tumour, inflammatory myofibroblastic tumour, angiosarcoma and adenoid cyst carcinoma reported in 0.7% each. Conclusion: Majority of the patients with CRC were in their young age. The most common presentations were diarrhoea, weight loss and anaemia. The most common site of affectation was in the left colon, while the most common histological finding was adenocarcinoma.

Background: Laparoscopic surgery for cancer located in the transverse colon or splenic flexure is difficult because of vascular variability in this region and adjacent vital organs such as the pancreas, spleen, and duodenum.Methods: This retrospective cohort study involved 51 patients who underwent laparoscopic surgery for colon cancer at Tokushima University Hospital from July 2015 to December 2020. Variations of the middle colic artery (MCA), left colic artery (LCA), middle colic vein (MCV), and first jejunal vein (FJV) and short-term outcomes of laparoscopic surgery in patients with each vascular variation were evaluated.Results: Variations of the MCA, LCA, MCV, and FJV were classified into four, three, five, and three patterns, respectively. The short-term outcomes of laparoscopic surgery for transverse colon cancer in patients with MCA variations and those with FJV variations were evaluated, and no significant difference was found in the operation time, blood loss, postoperative complication rate, time from surgery to start of dietary intake, or time from surgery to discharge among the different variations. Additionally, no significant differences were found in the short-term outcomes of laparoscopic surgery for descending colon cancer in patients with LCA variations.Conclusion: Preoperative assessment of vascular variations may contribute to the stability of short-term outcomes of laparoscopic surgery for transverse colon, splenic flexure, and descending colon cancer. [ABSTRACT FROM AUTHOR]

Neuroendocrine neoplasms are most often found in the small intestine, rectum, appendix, and stomach. The colon, excluding the appendix and the cecum, is a rare location for these neoplasms and often gives rise to highly proliferative, poorly differentiated tumors with aggressive features and dismal prognosis. A 32-year-old male presents with a large cell neuroendocrine carcinoma arising from an unusual location, the descending colon. The patient's clinical and imaging characteristics resembles those seen in the much more common neoplasm, colonic adenocarcinoma. Computed tomography and In-111 octreotide scan are limited in diagnosing large cell neuroendocrine carcinoma. Pathologic correlation of a surgical specimen is required to make the correct diagnosis.

A congenital band is an infrequent abnormality. Intestinal obstruction caused by an anomalous congenital band is very rare in children. Herein, we present the case of a 6-year-old patient with intestinal obstruction due to a congenital band. The compression was at the level of the descending colon. The location of the obstruction was determined by lower GI endoscopy, but the cause of the obstruction was diagnosed intraoperatively. The band was ligated and divided without intestinal resection. To the best of our knowledge, just four cases of large bowel obstruction due to congenital bands have been reported in the literature.

Gastrointestinal neuropathy in diabetes is one of numerous diseases resulting in abnormal functioning of the gastrointestinal tract (GIT), and it may affect any section of the GIT, including the descending colon. In the gastrointestinal system, the neurons are arranged in an interconnecting network defined as the enteric nervous system (ENS) which includes the myenteric plexus and the submucosal plexuses: inner and outer. Regular functioning of the ENS is determined by normal synthesis of the neurotransmitters and neuromodulators. This paper demonstrates the effect of hyperglycaemia on the number of enteric neurons which are immunoreactive to: neural isoform of nitric oxide synthase (nNOS), vasoactive intestinal peptide (VIP), galanin (GAL), calcitonin generelated peptide (CGRP) and cocaine amphetamine-regulated transcript (CART) in the porcine descending colon. It was demonstrated that there was a statistically significant increase in the number of neurons within the myenteric plexus immunoreactive to all investigated substances. In the outer submucosal plexus, the CART-positive neurons were the only ones not to change, whereas no changes were recorded for nNOS or CART in the inner submucosal plexus. This study is the first study to discuss quantitative changes in the neurons immunoreactive to nNOS, VIP, GAL, CGRP and CART in the descending colon in diabetic pigs. [ABSTRACT FROM AUTHOR]

Abstract Intramural hematoma of the colon should be considered as a diagnosis in anticoagulated patients who present with prolonged INR and GI symptoms. In stable cases, conservative medical treatment can be sufficient to avoid unnecessary procedures.

Intramural hematoma of the colon should be considered as a diagnosis in anticoagulated patients who present with prolonged INR and GI symptoms. In stable cases, conservative medical treatment can be sufficient to avoid unnecessary procedures. [ABSTRACT FROM AUTHOR]

The rotation of the midgut is essential for normal placement of intestines in the abdominal cavity. The process of midgut rotation and simultaneous retraction of the herniated intestinal loops pushes the hind gut to the left side of the abdominal cavity. So the descending colon and the sigmoid colon occupy the left side of the abdominal cavity. In this report, we document a male cadaver that revealed right-sided sigmoid colon. On further dissection, the descending colon was found lying in the midline with a small peritoneal fold stretching from the right side of sigmoid colon to ileocecal junction. There was also variation in the inferior mesenteric artery supplying the displaced descending colon and sigmoid colon. The possible embryological and molecular basis of this variation has been discussed. The anatomical knowledge of this variation is essential for interventional and diagnostic colonoscopy procedures and colonic surgeries. [ABSTRACT FROM AUTHOR]

Purpose Stage-IIIC colon cancer is an advanced disease; however, its oncologic outcomes and prognostic factors remain unclear. In this study, we aimed to determine the predictors of disease-free survival (DFS) in patients with stage-IIIC colon cancer. Methods From a multicenter database, we retrospectively enrolled 611 patients (355 men and 256 women) who had undergone a potentially curative resection for a stage-IIIC colon adenocarcinoma between 2003 and 2011. The primary end-point was the 5-year DFS. Results The median age was 62 years; 213 and 398 patients had right-sided colon cancer (RCC) and left-sided colon cancer (LCC), respectively. The 5-year DFS in all patients was 52.0%; median follow-up time was 35 months (range, 1–134 months). A multivariate Cox regression revealed that female sex (hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.19–1.90; P < 0.01), right-sided tumor location (HR, 1.65; 95% CI, 1.29–2.11; P < 0.01), lymphatic invasion (HR, 1.52; 95% CI, 1.08–2.15; P < 0.01) and a high (≥0.4) metastatic lymph node ratio (HR, 3.72; 95% CI, 2.63–5.24; P < 0.01) were independent predictors of worse 5-year DFS. Female patients with RCC were 1.79 fold more likely to experience recurrence than male patients with LCC. Conclusion Female sex and right-sided tumor location are associated with higher tumor recurrence rates in patients with stage-IIIC colon cancers. Aggressive treatment and close surveillance should be planned for patients in these groups.

Background: Colorectal cancer (CRC) is the most prevalent gastrointestinal (GI) cancer. With 5% risk of developing CRC in life, it became the third leading cause of cancer death in developed nations. In Nigeria, it is the most common GI cancer. However, there are limited data on CRC in the study area (North-Western part of Nigeria). The aim of this study was to identify the clinical, endoscopic and histological profile of CRC seen on colonoscopy. Methodology: This was a retrospective descriptive study where colonoscopic and histological records of suspected CRC in the study centre between January 2008 to December 2017 were evaluated. Results: Records of 135 patients were reviewed, and males constituted 63.7%. The mean age was 46.61 ± 16.80 years, with 30-39 years as a modal group. Common presentations were diarrhoea (86.7%) and bleeding per rectum (68.9%). Areas affected were rectosigmoid colon (63%), ascending colon (14.1%), descending colon (8.9%), transverse colon (7.4%) and anal canal (6.7%). Histologically, adenocarcinoma was reported in 57.8%, mucinous adenocarcinoma in 8.1% and signet ring cell adenocarcinoma in 3.7%. Tubular and villous adenomas were 3% each. Others were carcinoid tumours (1.5%), metastatic adenocarcinoma, squamous cell carcinoma, basal cell carcinoma, GI stromal tumour, inflammatory myofibroblastic tumour, angiosarcoma and adenoid cyst carcinoma reported in 0.7% each. Conclusion: Majority of the patients with CRC were in their young age. The most common presentations were diarrhoea, weight loss and anaemia. The most common site of affectation was in the left colon, while the most common histological finding was adenocarcinoma. [ABSTRACT FROM AUTHOR]

Primary epiploic appendagitis (PEA) re¬fers to inflammation in the epiploic appendages caused by spon¬taneous torsion, a hemorrhagic infarct. In general, PEA is a self-limiting disease, and most patients recover with conserva¬tive treatment in less than 10 days. Slightly male predominance is seen in PEA. The most common sites of acute PEA, in order of decreasing frequency, are sigmoid colon, the descending colon and the right hemicolon. This paper presents the clinical and radiological findings of a young adult male with complaints of abdominal left lower quadrant pain. The importance of differential diagnosis with diagnostic value of radiological methods are emphasized. [Med-Science 2016; 5(3.000): 893-9]

Intussusception is a rare event in adults which constitutes 1–3% of all cases of intestinal obstruction. Malignant etiology as causes of intussusception is more common in large bowel accounting for 60–65% cases. Intussusception due to colonic lipoma is rare. The present case is a 45-year-old woman who had a polypoidal growth in the descending colon. She was operated and the growth was histopathologically diagnosed as lipoma. Though rare, colonic lipoma should be considered as a probable etiology for intussusceptions.

The enteric nervous system (ENS) is the part of the nervous system that is located in the wall of the gastrointestinal tract and regulates the majority of the functions of the stomach and intestine. Enteric neurons may contain various active substances that act as neuromediators and/or neuromodulators. One of them is a gaseous substance, namely nitric oxide (NO). It is known that NO in the gastrointestinal (GI) tract may possess inhibitory functions; however, many of the aspects connected with the roles of this substance, especially during pathological states, remain not fully understood. An experiment is performed here with 15 pigs divided into 3 groups: C group (without any treatment), C1 group (“sham” operated), and C2 group, in which experimental inflammation was induced. The aim of this study is to investigate the influence of inflammation on nitrergic nervous structures in the muscular layer of the porcine descending colon using an immunofluorescence method. The obtained results show that inflammation causes an increase in the percentage of nitric oxide synthase (nNOS)-positive neurons in the myenteric plexus of the ENS, as well as the number of nitrergic nerve fibers in the muscular layer of the descending colon. The obtained results suggest that NO is involved in the pathological condition of the large bowel and probably takes part in neuroprotective and/or adaptive processes.

Introduction and Importance: Large bowel obstruction is a common surgical emergency worldwide. Large bowel obstruction secondary to descending colonic volvulus is an extremely rare condition with only few reported cases worldwide. Its extreme rarity is due to its retroperitoneal location and lack of mesentery., Case Presentation: A 75-year-old male patient with a history of sigmoidectomy and end-to-end descending colorectal anastomosis 19 years previously, presented with failure to pass faeces and flatus of 1 day duration with associated colicky abdominal pain, distension and vomiting. The abdomen was distended but soft and non-tender. Digital rectal examination showed an empty and ballooned rectum. The intraoperative finding was of a 360° counter-clockwise rotated descending colon. Detorsion and extraperitonealization of the descending colon was performed and the patient was successfully discharged., Clinical Discussion: Volvulus is a twisting of a segment of bowel along its own mesentery. Sigmoid volvulus and caecal volvulus accounts for up to 90% and less than 20% of cases, respectively. Descending colonic volvulus is described in very few case reports. Diagnosis is clinical and confirmed by imaging., Conclusion: Descending colonic volvulus is a surgical emergency and an extremely rare cause of large bowel obstruction. Surgical management options include extraperitonealization of the descending colon, diversion colostomy or resection and primary end-to-end anastomosis., Competing Interests: No potential conflict of interest relevant to this article was reported.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)