Neo-left colon volvulus or metachronous descending colon volvulus following sigmoidectomy for sigmoid volvulus

Sabri Selcuk Atamanalp

doi:10.5217/ir.2025.00015

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Brief Communication Miscellanoua Neo-left colon volvulus or metachronous descending colon volvulus following sigmoidectomy for sigmoid volvulus: Sabri Selcuk Atamanalp; Intestinal Research 2026;24(2):384-386.
DOI: https://doi.org/10.5217/ir.2025.00015
Published online: July 23, 2025

Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Türkiye

Correspondence to Sabri Selcuk Atamanalp, Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum 25040, Türkiye. E-mail: ssa@atauni.edu.tr

• Received: January 30, 2025 • Revised: May 2, 2025 • Accepted: June 18, 2025

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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REFERENCES

Sigmoid volvulus (SV) is an intestinal obstruction form arising from the torsion of the sigmoid colon around itself [1]. SV constitutes the most common type of colonic obstruction with an incidence of 1.67 patients per 100,000 persons per year in the United States. However, our practicing area, Eastern Anatolia, is an endemic region for SV [2]. The incidence of SV is 18.6 patients per year and 4.1 per 100,000 person-years in this region. Our tertiary referral center has 58.5 years (between June 1966 and January 2025) and 1,088 cases of experience with SV. These data consist of the most comprehensive single-center SV series over the world [3]. Based upon this experience, the present opinion letter relates to a relatively mysterious clinical description, neo-left colon volvulus (NLCV) or metachronous descending colon volvulus (MDCV) following sigmoidectomy for SV.

The descending colon is originally in retroperitoneal area. In clinical practice, solitary descending volvulus (DV) is extremely rare and partial DV typically accompanies transverse or SV [4,5]. However, the deperitonization of the descending colon during left colon or sigmoid colon surgery makes it an intraperitoneal vessel with its own mesentery, which is dubbed as “neo-left colon” (Fig. 1A and B). In the end, the remained descending colon with distal sigmoid colon or proximal rectum may rotate around its mesentery causing a volvulus. Practitioners generally rename the volvulus of this new colonic stricture as NLCV [6], while it is termed MDCV in cases with previous SV history [7,8].

SV is not a mystery for most gastroenterologists and surgeons due to its relatively high incidence. However, NLCV or MDCV is a quite rare clinical entity, which gained currency in recent years [6,7]. An electronic data search under the head of “neo-left colon volvulus or metachronous descending colon volvulus” of the last 80 years’ literature (from 1945 to date) in Web of Science [9] and PubMed [10] databases revealed limited availability of publications on this subject. The detailed research of above-mentioned reports demonstrated 6 cases in association with NLCV or MDCV following sigmoidectomy. Among them, primary pathology was SV in 4 cases [7,8,11,12], while colonic carcinoma in the remaining 2 cases [6,13]. However, easy and early diagnosis of SV and colonic malignancies due to advanced endoscopic or radiological diagnostic procedures and improved prognosis arising from laparoscopic colon surgery may cause an increase in number of such cases in the near future [13-15].

Characteristics obtained from 6 patients presented in the literature are summarized in Table 1. A medical history of a previous left colon surgery is an important mnemonic in the diagnosis of NLCV or MDCV. Most likely, due to previous SV in most cases, these clinical entities generally occur in elderly men [6-8,11-13]. Abdominal pain/tenderness, distention, and inability to pass stool or gas are the main clinical features similar to primary SV, while vomiting, empty rectum in digital examination, and hyperkinetic bowel sounds are other symptoms and signs [7,8,11,12]. Erect abdominal X-ray radiographs show distended large bowel loops and multiple air-fluid levels, which suggest colon obstruction [6-8,11,12]. Computed tomography is diagnostic by demonstrating 2 transition points in the left colon with swirling of the mesentery in addition to dilatation in proximal left colon, indicative of colon volvulus (Fig. 1C) [6,7,11-13]. Endoscopic decompression is the primary treatment option in uncomplicated patients [12,13]. However, emergency surgery, preferably laparoscopic procedure, is required in cases with bowel gangrene or unsuccessful endoscopic decompression [6-8,11]. As surgical procedure, colectomy is an unavoidable situation in gangrenous cases, while extraperitonealization is less invasive in patients with viable bowel [7,8,11]. Although operative detorsion alone is an option, due to its high recurrence rate, colopexy (percutaneous endoscopic or preferably laparoscopic) is another alternative, which may prevent recurrence [3,6,7,13].

In our SV series, 490 patients (45.0%) were treated with emergency surgery (sigmoidectomy with stoma in 206 patients, sigmoidectomy with primary anastomosis in 175, mesopexy in 57, detorsion in 47, extraperitonealization in 4, and laparotomy in 1). However, we have no experience on NLCV or MDCV. It is clear that, to prevent NLCV or MDCV is more important than to diagnose and treat them. In my opinion and experience, the main rule of SV surgery to prevent or reduce NLCV or MDCV as well as recurrent SV, is the resection of maximal sigmoid colon segment with minimal deperitonization of the descending colon (or even left flexure), allowing a tension-free anastomosis.

NOTES

Funding Source

The author received no financial support for the research, authorship, and/or publication of this article.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Data Availability Statement

Data are available from the corresponding author upon reasonable request.

Author Contributions

Writing and approval of the final manuscript: Atamanalp SS.

Fig. 1.

Schematic diagram showing (A) normal colon, (B) neo-left colon, and (C) neo-left colon volvulus. C, cecum; A, ascending colon; T, transverse colon; D, descending colon; S, sigmoid colon; R, rectum; N, neo-left colon; M, mesentery; 1, proximal transition point; 2, distal transition point; 3, mesenteric whirling; 4, dilated proximal neo-left colon.

Table 1.

Characteristics of Patients with Neo-Left Colon Volvulus or Metachronous Descending Colon Volvulus

Characteristic	Evaluation, No. (%)
Age (yr), mean (range)	68.5 (35–86)
Sex
Male	4/5 (80.0)
Female	1/5 (20.0)
Previous pathology
Sigmoid volvulus	4/6 (66.7)
Colonic malignancy	2/6 (33.3)
Clinical features
Abdominal pain/tenderness	4/4 (100.0)
Abdominal distention	4/4 (100.0)
Obstipation	4/4 (100.0)
Vomiting	2/4 (50.0)
Empty rectum in digital examination	2/4 (50.0)
Hyperkinetic bowel sound	1/4 (25.0)
Radiological findings
Abdominal X-ray radiography demonstrating dilated large bowel loops with multiple air-fluid levels, consistent with colon obstruction	5/5 (100.0)
Computed tomography presenting 2 transition points in the left colon with mesenteric whirling and dilatation in proximal left colon, indicative of colon volvulus	3/3 (100.0)
Treatment options
Endoscopic detorsion	2/6 (33.3)
Open resection with stoma	2/6 (33.3)
Laparoscopic colopexy	1/6 (16.7)
Open extraperitonealization	1/6 (16.7)

REFERENCES

1. Brown J, Dick L, Watson A. Volvulus of the gastrointestinal tract. Br J Hosp Med (Lond) 2024;85:1–9.Article
2. Atamanalp SS, Disci E, Peksoz R. Sigmoid volvulus and concomitant clinical entities. Formos J Surg 2023;57:87–92.Article
3. Atamanalp SS, Disci E, Peksoz R, Atamanalp RS, Atamanalp CT. Management of sigmoid volvulus: a literature review. Ibnosina J Med Biomed Sci 2024;16:5–9.Article
4. Shibata J, Tomida A, Hattori M, Yoshihara M. Transverse colon volvulus secondary to the persistent descending mesocolon: a case report. Cureus 2024;16:e61272.Article PubMed PMC
5. Kato H, Kinoshita H, Sakata Y. Acute abdominal pain due to sigmoid volvulus with persistent descending mesocolon: a case report. J Med Case Rep 2022;16:349.Article PubMed PMC PDF
6. Huynh R, Reece M, Mansouri D, Nguyen TM, Keshava A. Laparoscopic colopexy for neo-left colonic volvulus 10 years after anterior resection. J Surg Case Rep 2020;2020–rjaa555.Article PDF
7. Kebede MA, Mohammed SM, Numaro YT, et al. Metachronous volvulus of the descending colon after resection of the sigmoid volvulus: a case report. Int J Surg Case Rep 2024;123:110212.Article PubMed PMC
8. Amare AG, Workneh GA, Tassew MT, et al. Metachronous descending colon volvulus after sigmoidectomy: a case report. J Surg Case Rep 2025;2025–rjae827.Article PDF
9. Web of Science. Neo left colon volvulus or metachronous descending colon volvulus [Internet]. c2025 [cited 2025 Jan 30]. https://www.webofscience.com/wos/woscc/summary/32cbf919-f0bd-494a-98d3-e6fa60cc9fca-016d44cbbd/relevance/1.
10. PubMed. Neo left colon volvulus or metachronous descending colon volvulus [Internet]. c2025 [cited 2025 Jan 30]. https://pubmed.ncbi.nlm.nih.gov/?term=Neo+left+colon+volvulus+or+metachronous+descending+colon+volvulus.
11. Abebe TA, Berhe YW, Seid OA, Sefefe WM, Lake LK. A rare case of descending colonic volvulus presenting as large bowel obstruction 19 years after sigmoidectomy and descending colorectal anastomosis. Ann Med Surg (Lond) 2024;86:2143–2148.Article PubMed PMC
12. Van J, Economou I. S1792 a case of descending colon volvulus following sigmoid volvulus status post sigmoidectomy. Am J Gastroenterol 2020;115:S927.Article
13. Moritz C, Scheiwe C, Malgras B. Colonic volvulus after laparoscopic left colectomy. J Visc Surg 2020;157:493–494.Article PubMed
14. Atamanalp SS. Left colon volvulus following sigmoidectomy. Chall J Perioper Med 2025;3:30–31.Article PDF
15. Namgung Y, Song HJ, Han J, Kim HU. Sigmoid volvulus: clinical manifestations and prognosis based on treatment. Gastrointest Endosc 2024;99(Suppl): AB540–AB451.Article

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Neo-left colon volvulus or metachronous descending colon volvulus following sigmoidectomy for sigmoid volvulus

Intest Res. 2026;24(2):384-386. Published online July 23, 2025

DOI: https://doi.org/10.5217/ir.2025.00015

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Figure

Neo-left colon volvulus or metachronous descending colon volvulus following sigmoidectomy for sigmoid volvulus

Fig. 1. Schematic diagram showing (A) normal colon, (B) neo-left colon, and (C) neo-left colon volvulus. C, cecum; A, ascending colon; T, transverse colon; D, descending colon; S, sigmoid colon; R, rectum; N, neo-left colon; M, mesentery; 1, proximal transition point; 2, distal transition point; 3, mesenteric whirling; 4, dilated proximal neo-left colon.

Fig. 1.

Neo-left colon volvulus or metachronous descending colon volvulus following sigmoidectomy for sigmoid volvulus

Characteristic	Evaluation, No. (%)
Age (yr), mean (range)	68.5 (35–86)
Sex
Male	4/5 (80.0)
Female	1/5 (20.0)
Previous pathology
Sigmoid volvulus	4/6 (66.7)
Colonic malignancy	2/6 (33.3)
Clinical features
Abdominal pain/tenderness	4/4 (100.0)
Abdominal distention	4/4 (100.0)
Obstipation	4/4 (100.0)
Vomiting	2/4 (50.0)
Empty rectum in digital examination	2/4 (50.0)
Hyperkinetic bowel sound	1/4 (25.0)
Radiological findings
Abdominal X-ray radiography demonstrating dilated large bowel loops with multiple air-fluid levels, consistent with colon obstruction	5/5 (100.0)
Computed tomography presenting 2 transition points in the left colon with mesenteric whirling and dilatation in proximal left colon, indicative of colon volvulus	3/3 (100.0)
Treatment options
Endoscopic detorsion	2/6 (33.3)
Open resection with stoma	2/6 (33.3)
Laparoscopic colopexy	1/6 (16.7)
Open extraperitonealization	1/6 (16.7)

Table 1. Characteristics of Patients with Neo-Left Colon Volvulus or Metachronous Descending Colon Volvulus