What can cause the colon to become transverse?

Causes of Transverse Colon Position Abnormalities

The most common causes of abnormal transverse colon positioning include anatomical variations, sigmoid volvulus, colonic obstruction, and surgical interventions. 1

Anatomical Variations

• Dolicho-colon: An elongated colon with a narrow mesenteric base is a common anatomical predisposition that can cause the transverse colon to be abnormally positioned 1
• Retrogastric colon: The transverse colon can abnormally position itself between the stomach and pancreas (pancreaticogastric interposition) or behind the spleen (retrosplenic position), occurring in approximately 0.3% of individuals 2, 3
• Hepatodiaphragmatic interposition: The colon can position itself between the liver and diaphragm in either an anterolateral (2.1% of cases) or posterior (0.3% of cases) configuration 3
• Congenital abnormalities: Mild embryologic abnormalities of bowel rotation and fixation can lead to abnormal transverse colon positioning 3

Pathological Causes

• Colonic obstruction: When obstruction occurs, particularly in the left colon, the transverse colon can become distended and displaced from its normal anatomical position 1
• Sigmoid volvulus: The twisting of the sigmoid colon can cause mechanical changes that affect the position of the transverse colon 1
• Intra-abdominal adhesions: Previous surgeries or inflammatory conditions can create adhesions that pull the transverse colon into abnormal positions 2
• Colonic tumors: Advanced tumors, particularly those causing obstruction, can alter the normal position of the transverse colon 1

Contributing Factors

• Short transverse mesocolon: Limits the normal mobility of the transverse colon and can lead to abnormal positioning 3
• Intraperitoneal ascending or descending colon: Alters the normal fixation points of the colon 3
• Increased intraperitoneal pressure: Can push the transverse colon into abnormal spaces 3
• Decreased retroperitoneal fat: Provides less cushioning and support for normal colon positioning 3
• Chronic constipation: Can lead to elongation and displacement of the transverse colon over time 1
• High-fiber diet: Associated with elongated colon development which can predispose to abnormal positioning 1

Clinical Implications

• Symptomatic presentations: Abnormally positioned transverse colon can cause chronic constipation, abdominal pain, nausea, and weight loss 2
• Surgical considerations: Abnormal transverse colon positioning presents challenges during laparoscopic procedures due to variations in mesenteric vascular anatomy and complex surrounding structures 4
• Diagnostic challenges: These variations can mimic other pathologies on imaging studies and may lead to misdiagnosis 3
• Procedural risks: During percutaneous interventions and surgical procedures, an abnormally positioned colon may be at risk for perforation if not recognized 3

Rare Causes

• Colon duplication: A rare congenital abnormality that can affect the transverse colon and cause chronic constipation 5
• Umbilical hernias: The transverse colon can extend into umbilical or other ventral hernias, creating unusual configurations 6

Management Considerations

• Preoperative imaging: CT scans with vascular reconstruction are essential to identify anatomical variations before surgical intervention 4
• Surgical approach: For symptomatic cases requiring surgery, a four-directional approach to the meso-transverse attachment combined with preoperative radiological simulation can facilitate safer laparoscopic procedures 4
• Emergency management: In cases of acute obstruction or perforation, damage control surgery principles should be applied with consideration for the patient's stability 1