Colon volvulus is a common cause of intestinal obstruction. The sigmoid colon is the segment most susceptible to this pathology; however, the transverse colon is the least affected segment. A colonic volvulus with dual localization, constitutes a rare entity of obstruction [7].

Colon volvulus has several factors that can be grouped into three categories:

• Congenital factors: intestinal malrotations, Hirschsprung’s disease, the lack of fixation of the right colon or splenic angle, shortening of the mesocolon [8,9].
• Anatomical factors leading to abnormal mobility of the colon: dolichocolon, associated with or without the megacolon or Chilaiditi syndrome, chronic inflammatory disease [10].
• Physiological factors: chronic constipation and/or overuse of laxatives leading to motility disturbances [11].

The etiological factors of colon volvulus are relatively the same regardless of the site. However, these different factors are often associated and have a synergistic effect in the increased mobility of the colon that predisposing it to the volvulus [12].

The two main problems in the colonic volvulus are the bowel obstuction and the vacular occlusion. The first one lead to the distention of the twisted loop due to mechanical obstruction and bacterial fermentation. On second place, the vascular occlusion and the colonic distention by decresing capillary perfusion due to the intra colonic pressure, lead to ichemia that lead to bacterial translocation and toxemia and to the colonic gangrene [13-18].

Clinically, the patient presents an occlusive syndrome, often accompanied by other symptoms such as vomiting and rectal bleeding. On abdominal examination, the patient presents an asymmetric abdominal distension on inspection and Von Wahl sign in palpation. The presence of rectal melanotic stool, rebound tenderness or muscular defense generally is a sign of complication like gangrene, perforation and peritonitis [19,20].

Plain abdominal radiography has been found diagnostic in 57%-90% of patients by showing various characteristic signs, notably omega or horseshoe sign, bird beak sign, inverted U sign, northern exposure sign, coffee bean sign. But all this signs are not found if there is a simultaneous volvulus [21-24].

The CT scan has better sensitivity and specificity in the diagnosis by showing the whirl sign. The presence of two concomitant whirl sign may suggest a simultaneous volvulus [25,26]. However the preoperative diagnosis of the simultaneous volvulus remains challenging and often discovered during the surgery [27,28].

The endoscopic derotation is the gold standard for sigmoid volvulus if there is no sign of necrosis or perforation, in second plan a colectomy. However, the first surgical approach is the most common due to the financial problem or lack of endoscopic equipment and it consist of a segmentary resection and colostomy or anastomosis but in emergency on an unprepared colon exposes to a lot of morbidities (fistula, sepsis) [25,29,30].

On the dual volvulus of the left colon, the surgical approch consist of left hemicolectomy with anastomosis if there is no necrosis and the patient is hemodynamically stable. Therefor delayed anastomosis seems to be the best option by reducing the risk of anastomotic leakage and morbidity [31-33].