An uncommon cause of acute abdomen in an acromegalic patient: colonic volvulus

Abstract

Acromegaly is a chronic endocrine disease, typically caused by a pituitary adenoma leading to increased circulating GH levels and increased IGF-I secretion by peripheral tissues. Gastrointestinal diseases related acromegaly such as colon cancers, adenomatous polyps, and dolichocolon are much less known. We aimed to present a case of complete colonic volvulus in a patient with acromegaly. A 60-year-old male patient presented with the complaints of inability to pass gas or stool, worsening distension, and pain for one week. The clinical exam showed significant tenderness and distended abdomen as well as a typical appearance of acromegaly. In his past medical history, he underwent an operation of pituitary adenoma with the diagnosis of acromegaly. He also underwent a sigmoid colon resection due to dolichocolon detected by abdominal computerized tomography (CT) and colonoscopy. Upright abdominal X-ray was compatible with volvulus, so endoscopic distortion was tried but failed. At exploration, entire colon was extremely dilated and had a necrotic appearance, and observed to be twisted 360 degrees around its mesenteric axis. The patient underwent total colectomy and end ileostomy. Pathology result was reported as necrotic and hemorrhagic colon with 150 cm in length and 20 cm in width. The patient was discharged on the 14th postoperative day without complications. GH and IGF-1 have an irreversible effect on colonic collagen synthesis in acromegaly and has been proposed to be correlated with the presence of dolichocolon. Dolichocolon often can lead to an abnormal rotation, volvulus, and development of Chilaiditi syndrome. The occurrence of volvulus including the whole colon, although the pituitary adenoma was treated and partial colectomy was done, refers to predisposing factor being the irreversible effect of acromegaly on the colon.