Volvulus: a rare twist on small-bowel obstruction

Case Report: Splenic Ischemia Induced by Volvulus of Ileum

A 31-year-old female patient was admitted to the emergency department with signs and symptoms of acute abdomen. Urgent CT scan was performed and small bowel volvulus, with whirlpool sign, was noted and torsion of the spleen was also involved too.

Primary ileal volvulus: a rare twist in an elderly patient-case report

Background

Small bowel volvulus is a rare entity and it is even rarer for the ileum to undergo torsion without any known predisposing factors. It presents as acute abdomen with features of intestinal obstruction. As it is a life-threatening condition, it should be kept as a differential for small bowel obstruction despite its rarity. Therefore, we report this case.

Case report

A 60-year-old gentleman presented to our emergency department with a 2-day history of worsening abdominal pain, vomiting, abdominal distension and obstipation. Exploratory laparotomy was done which revealed ileal volvulus with no predisposing factors. Derotation of the segment was done. The postoperative period was uneventful and on follow up after a month, he had a satisfying recovery.

Conclusion

Though primary ileal volvulus is a rare diagnosis, it should be kept in mind in any patient with small bowel obstruction with pain out of proportion and resistant to opioid management. Early diagnosis and urgent surgical intervention is the key to prevent bowel necrosis and associated morbidity and mortality.

Small bowel volvulus around caesarian section scar adhesions

Small bowel obstruction secondary to adhesions is a recognized complication of Caesarian section. However, obstruction due to small bowel volvulus caused by adhesions at the Caesarian-section scar has not been reported. We report such a case identified on computed tomography. We review the literature on small bowel volvulus in pregnant patients and discuss the computed tomography findings.

Small Bowel Volvulus: A Case Report

Small bowel volvulus is a rare clinical entity which presents as recurrent intermittent abdominal pain after consumption of food. Although the entity is well described in the literature, diagnosis is often difficult due to its clinical presentation being similar to mesenteric ischemia. Herein we present the case of a 44-year-old male who presented to us with this condition.

A Fatal Twist: Volvulus of the Small Intestine in a 46-Year-Old Woman

A 46-year-old woman presented to two emergency departments within 12 hours because of acute abdominal pain. Physical exam demonstrated tenderness and epigastric guarding. An ultrasound was interpreted as negative; she was discharged home. Later that evening, she was found dead. Postmortem exam revealed acute hemorrhagic necrosis of a segment of jejunum secondary to volvulus. Clinical clues suggesting presentations of small bowel volvulus are usually nonspecific; the diagnosis is typically confirmed at surgery. Her unremitting abdominal pain, persistent vomiting, and absolute neutrophilia were consistent with an acute process. The etiology of this volvulus was caused by an elastic fibrous band at the root of the jejunal mesentery. While congenital fibrous bands are rare in adults, this interpretation is favored for two reasons. First, the band was located 20 cm superior to postsurgical adhesions in the lower abdomen and pelvis. Second, there was no history of trauma or previous surgery involving the site of volvulus.

An Unusual Case of Small Bowel Volvulus

Small bowel volvulus is a rare and life threatening surgical emergency. Nearly 75% of volvulus occurs in colon and 25% occurs in small bowel. Small bowel volvulus is abnormal twisting of bowel loops around the axis of its own mesentry leading to twisting and occlusion of mesenteric vessels causing intestinal obstruction, venous engorgement, gangrene and perforation. Small bowel volvulus is more common in neonates and young adults and very rare in adults. We are reporting a first case of small bowel volvulus and gangrene caused by herniation of ovarian cyst through mesenteric defect and twisting of small bowel around the axis of ovarian cyst leading to closed loop obstruction, small bowel volvulus and gangrene. Outcome of the disease is mainly based on the early diagnosis and intervention. Mortality is about 5.8 - 8% in nongangrenous SBV which increases drastically to 20 - 100% in gangrenous bowel.

Multiphasic MDCT in small bowel volvulus

OBJECTIVE

Evaluate the use of MDCT with 3D CT angiography (CTA) and CT portal venography (CTPV) reconstruction for the diagnosis of small bowel volvulus (SBV).

METHODS

Multiphasic MDCT findings in nine patients (seven males and two females, age range 2-70) with surgically proven SBV were retrospectively reviewed. Non-contrast and double phase contrast enhanced MDCT including 3D CTA and CTPV reconstruction were performed in all the patients. Two experienced abdominal radiologists evaluated the images and defined the location, direction and degree of SBV.

RESULTS

On axial MDCT images, all cases show segmental or global dilatation of small intestine. Other findings include circumferential bowel wall thickening in eight cases, halo appearance and hyperemia in seven cases, whirl sign in six cases, beak-like appearance in six cases, closed loops in six cases and ascites in one case. CTA/CTPV showed abnormal courses involving main trunks of superior mesenteric artery (SMA) and superior mesenteric vein (SMV) in seven cases, with or without distortion of their tributaries. Normal course of SMA but abnormal course of SMV was seen in the other two cases. Of all the nine cases, whirl sign was seen in six cases and barber's pole sign in five cases. Dilated SMV was observed in eight cases and abrupt termination of SMA was found in one case. Compared with surgical findings, the location, direction and degree of SBV were correctly estimated in all cases based on CTA/CTPV.

CONCLUSION

Multiphasic MDCT with CTA/CTPV reconstruction can play an important role in the diagnosis of SBV. The location, direction and degree of SBV can all be defined preoperatively using this method.

Small bowel volvulus diagnosed by the CT "whirl sign"

A 24-year-old man presented to the emergency department with acute onset, colicky, abdominal pain. A CT scan showed the "whirl sign" diagnostic of small bowel volvulus. Diagnosis of a small bowel volvulus can be challenging, and CT scan is the imaging modality of choice.

Duodenal Volvulus: Report of a Case

A duodenal volvulus is a hitherto unreported condition caused by an abnormal mobility of the third and fourth parts of the duodenum. We herein report the first such case, including its presentation, management, and possible etiology.

Small bowel volvulus secondary to a mesenteric lipoma: a case report and review of the literature

BACKGROUND

Small bowel volvulus is rare in adults and often has a precipitating factor.

METHODS

This report describes a case of small bowel volvulus secondary to a mesenteric lipoma and reviews the literature describing this condition.

CONCLUSION

Mesenteric lipoma is a rare precipitating cause of small bowel volvulus in adults. Computed tomography scanning may be useful for diagnosis preoperatively. The treatment of choice is surgery with complete excision of the lipoma.

Comparison of mechanical bowel obstruction cases of intra-abdominal tumor and non-tumoral origin

INTRODUCTION

Mechanical bowel obstruction cases constitute an important place in emergency health care services. In this study, bowel obstructions caused by intra-abdominal tumors were compared with those without tumoral causes.

PATIENTS AND METHODS

A total of 155 cases of mechanical bowel obstruction diagnosed were retrospectively evaluated. The cases resulting from abdominal wall hernias were excluded. Neoplasia cases were classified as group I, and all other cases as group II.

RESULTS

Group I totaled 46 patients (30%); group II, 109 (70%). The difference between two groups in terms of gender was found to be statistically insignificant, but the difference in terms of age range was significant (P<0.05). The etiology of group II cases included intra-abdominal strictures (n=68), volvulus (n=15), internal herniation (n=7), Meckel's diverticulum (n=7), tuberculous peritonitis (n=4), foreign body (n=4), invagination (n=2), and inflammatory bowel disease (n=2). Previous surgical operations had been performed in 9 patients (19%) of group I and 52 patients (47%) of group II. The difference between two groups in terms of bowel obstruction localization was significant (chi2: 37.78, P<0.0001). Group I had a significantly higher morbidity and mortality than group II (P<0.01 and P<0.001).

CONCLUSIONS

Non-tumoral cases causing intra-abdominal mechanical bowel obstruction occur mostly in younger people and in patients with previous surgical operation. Patients in older ages or who haven't had any surgical intervention must be operated as soon as possible because of the high rate of malignancy.