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Plain X-ray abdomen showing dilated bowel loops, multiple air-fluid levels and absence of gas in colon
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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...
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Gastric volvulus is a rare cause of recurrent abdominal pain or vomiting. This report presents a case of a 12-year-old girl with acute gastric volvulus and 2-hour history of epigastric pain after overeating. Computed tomography showed severe gastric distension without other abnormal findings. The gastric fluid decompressed through a nasogastric tub...
The case of a 71-year-old patient was presented who had diffuse colicky abdominal pain predominantly in the lower abdomen for three months prior to admission, accompanied by intermittent abdominal distention, vomiting in an unspecified amount and frequency of food content. During the physical examination, the patient was found to be in fair conditi...
Introduction: Caecal volvulus is an infrequent cause of adult bowel obstruction which involves torsion involving the caecum and terminal ileum around its mesentery. The aim of this review is to promote the surgeon's awareness of this form of bowel obstruction through a patient case discussion and management strategies for treating caecal volvulus....
Citations
... In our case, we were able to reduce the torsional segment laparoscopically, and segmental resection and fixation were unnecessary as the bowel segment remained viable, regained its normal color, and no secondary cause was identified. Depending on the individual case, a laparoscopic approach may also benefit patients due to reduced pain, tissue damage, recovery time, and hospital stay associated with the laparoscopic approach [20,21]. However, the laparoscopic approach requires a high level of surgical skill and experience, and it may not be feasible in cases of extensive bowel necrosis or perforation [5]. ...
Introduction: Small bowel volvulus (SBV) is a surgical emergency that requires prompt diagnosis and treatment. Although sudden onset acute abdominal pain is the most common presenting symptom, the clinical presentation of SBV can be misleading. Early diagnosis and treatment are therefore crucial for a good outcome. Case Report: A 49-year-old woman presented with a 5-hour history of nausea as her only symptom. Six hours after admission, she developed multiple episodes of vomiting, but without abdominal pain. An urgent CT of the abdomen revealed a pathognomonic “whirl” pattern highly suggestive of SBV, and emergency laparoscopy revealed ileal volvulus without any identifiable pathoetiological factors. She underwent simple devolvulation and made a rapid recovery without recurrence at 12 months. Conclusion: This case highlights that the preoperative clinical diagnosis of small bowel volvulus can be challenging, emphasizing the importance of preoperative imaging and maintaining a high index of suspicion to avoid missing this important diagnosis. A laparoscopic approach can be used successfully to treat SBV.
... 8 Even though there are no generally accepted explanations offered, research outputs postulated that several different predisposing factors might act combined to result in primary small bowel volvulus. 5,6,9,[11][12][13][14] Wide variations in small bowel length among individuals were observed in different studies; [15][16][17][18][19][20] however, their role in primary small bowel volvulus was barely studied. Longer mesenteric length and short mesenteric root were hypothesized and reported to allow abnormal mobility of the entire or a segment of small bowel. ...
Agegnehu Bayeh,1 Belta Abegaz2 1Department of Surgery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia; 2Department of Biomedical Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, EthiopiaCorrespondence: Agegnehu Bayeh, Department of Surgery, College of Medicine and Health Sciences, Bahir Dar University, PO Box 79, Bahir Dar, Ethiopia, Tel +251 923486085, Email agegnehuberie@gmail.comBackground: Anatomic dimensions of jejunum and ileum have been known to vary among individuals; however, their role in the development of primary small bowel volvulus was barely studied. The main objective of this study was to assess the role of small bowel anatomic dimensions in the development of primary small bowel volvulus.Methods and Materials: A prospective case-control study to compare small bowel anatomic dimensions between patients with intraoperatively confirmed primary small bowel volvulus (cases) and control groups was conducted from December 2019 to December 2020 at Tibebe Ghion Specialized Hospital (TGSH) and Felege Hiwot Comprehensive Specialized Hospital (FHCSH), two referral hospitals in Bahir Dar city, NorthWestern Ethiopia. Jejunoileal length, mesenteric length, mesenteric root, and the ratio of small bowel mesenteric length to small bowel mesenteric root were compared between cases and controls using unpaired Student’s t-test, Welch’s t-test, or Mann–Whitney U-test at p-value ≤ 0.05 (two-sided).Results: A total of 78 participants (39 cases and 39 controls) were included and analyzed in the study. Twenty-nine (74.4%) cases and 18 (46.2%) controls were males. The mean ages in years for cases and controls were 40.2 (SD=14.1) and 46.6 (SD=15.0), respectively. The study showed that patients with primary small bowel volvulus had statistically significantly longer small bowel length and small bowel mesenteric length than controls, but small bowel mesenteric root was found not to be statistically significantly different between cases and controls. The Mann–Whitney U-test for the comparison of the ratio of small bowel mesenteric length to small bowel mesenteric root showed that the mean rank was statistically significantly higher in cases than in the controls.Conclusion: A longer small bowel with longer mesentery and higher small bowel mesenteric length to small bowel mesenteric root ratio is highly likely to predispose individuals to primary small bowel volvulus.Keywords: bowel obstruction, intestine, jejunum, ileum, human anatomy, mesentery
... Secondary SBV is mainly due to postoperative adhesions, fibrous band, Meckel's diverticulum, congenital malrotation of the gut, tumours, mesenteric lymph nodes, parasitic infestations, internal hernias, lipomas, pregnancy, endometriosis, hematomas, aneurysms, tuberculosis, intestinal duplication, jejunal diverticulum, small bowel diverticula, paraduodenal hernia. [6,8,9]. This is the first case of a JV secondary to a inguinal hernia reported in the literature: we suppose that the presence of jejunal loops within the inguinal hernia sac have induced forceful bowel peristalsis resulting in JV. ...
... Color Doppler US can demonstrate the encircling of the small bowel loops and the superior mesenteric vein around the superior mesenteric artery, which is termed the "whirlpool sign", with a sensitivity, specificity and positive predictive value of 92%, 100% and 100% respectively [15]. Abdominal CECT represents the investigation of choice with a sensitivity of 60%-100% and a specificity of 90%-95% [16]: it can demonstrate "whirl sign", "spoke wheel sign", "beak sign", "barber pole signs", signs of small bowel obstruction (dilatation of closed or air-filled bowel loops) and ischemia (thickening or presence of air in the bowel wall, portal vein gas, free peritoneal fluid); however none of these findings is pathognomonic of SBV [8]. M. Lepage-Saucier et al. observed on abdominal CECT three signs of SBV which are multiple transition points, transition points located ≤7 cm from the spine in the anteroposterior plane and the whirl sign: the presence of any one of these signs confirms SBV with a sensitivity of 94%, the presence of all signs confirms SBV with100% specificity [1]. ...
Introduction and importance
Small bowel volvulus (SBV) represents a rare and life-threatening cause of gastrointestinal obstruction among adults. SBV can be classified as primary and secondary subtypes. Preoperative diagnosis of SBV is a challenge because of the absence of pathognomonic clinical, radiographic and laboratory findings. Surgery represents the correct treatment of SBV.
Case presentation
A 69-year-old Caucasian male presented to the Emergency Department with a two-day history of abdominal pain, inability to pass gas or stool, nausea, vomiting. Physical examination revealed abdominal distension, generalized abdominal pain without guarding or rebound tenderness, a partially reducible and painless right inguinal hernia. Laboratory tests reported neutrophilic leukocytosis. Abdominal computed tomography revealed massive gastroduodenal dilatation with pneumoperitoneum and small bowel loops in the right inguinal sac. The patient underwent exploratory laparotomy: a jejunal volvulus (JV) located within the right inguinal hernia sac, causing gastrointestinal obstruction, was devolvulated and a right prosthetic inguinal hernia repair was also performed. The patient was discharged on the 10th postoperative day.
Clinical discussion
Secondary SBV is due to any congenital or acquired lesions and rarely occurs among adults in Western countries. This is the first literature report of a JV located within an inguinal hernia sac causing gastrointestinal obstruction.
Conclusion
Secondary JV represents an extremely rare abdominal emergency necessitating early diagnosis to prevent the development of intestinal ischemia, bowel necrosis and peritonitis. Diagnosis of JV needs a high index of suspicion and may be facilitated by imaging, often it is made intraoperatively. Surgery represents the appropriate treatment of JV.
... 16 While mortality is raised significantly in the presence of gangrenous bowel, there is potential for patients to recover uneventfully after detorsion of SBV without bowel resection. [2][3][4]9,19,20 In patients who appear clinically well after the first exploration, it seems reasonable to take a relaparotomy on-demand approach. In our case, a markedly ischemicappearing bowel segment fully recovered while sparing the patient the additional risks and complications of bowel resection or a second surgery. ...
Small bowel volvulus is a rare but important cause of abdominal pain and small bowel obstruction in children and adults. In the neonate, small bowel volvulus is a well-known complication of malrotation. Segmental small bowel volvulus is a lesser-known condition, which occurs in children and adults alike and can rapidly progress to bowel ischemia. Primary segmental small bowel volvulus occurs in the absence of rotational anomalies or other intraabdominal lesions and is rare in Europe and North America. Clinical presentation can be misleading, causing a delay in diagnosis and treatment, in which case the resection of necrotic bowel may become necessary.
We report on a 14-year-old girl who presented with severe colicky abdominal pain but showed no other signs of peritoneal irritation or bowel obstruction. An emergency magnetic resonance imaging was highly suspicious for small bowel volvulus. Emergency laparotomy revealed a 115 cm segment of strangulated distal ileum with no underlying pathology. We performed a detorsion of the affected bowel segment. Despite the initial markedly ischemic appearance of the affected bowel segment, the patient achieved full recovery without resection of bowel becoming necessary.
... Midgut volvulus in adults is rare, with only about 120 case reports and an additional 200 patients in case series reported in the literature as of 2020 [1]. Previous case reports have reported recurrent midgut volvulus in patients with a history of childhood Ladd's procedure [1], or an isolated incident of volvulus in elderly patients with no predisposing factors [2]. Cases in the elderly were managed with simple untwisting of the mesentery [2,3]. ...
... Previous case reports have reported recurrent midgut volvulus in patients with a history of childhood Ladd's procedure [1], or an isolated incident of volvulus in elderly patients with no predisposing factors [2]. Cases in the elderly were managed with simple untwisting of the mesentery [2,3]. Overall, it is exceedingly rare to encounter primary midgut volvulus in adult patients with neither evidence of intestinal malrotation nor mechanical causes of volvulus, such as jejunal diverticula [4]. ...
We present a rare case of recurrent primary midgut volvulus in an elderly female with an interesting intraoperative finding of an abnormally elongated small bowel mesentery. This patient presented with symptoms of obstruction, including nausea, vomiting and obstipation, similar to previous episodes of volvulus for which she underwent exploratory laparotomies and reduction of the volvulus. We describe a novel use for enteropexy in which we effectively shortened the small bowel mesentery in an effort to eliminate the source of recurrent volvulus. The patient’s post-operative course was complicated by prolonged ileus requiring total parenteral nutrition. However, she had not developed signs or symptoms of bowel ischemia or recurrent volvulus at the time of this writing. Our findings suggest that enteropexy is an effective technique for preventing recurrent midgut volvulus primarily caused by abnormally elongated mesentery.
Introducción: El vólvulo intestinal es una condición infrecuente caracterizada por la torsión anormal de un asa intestinal alrededor de su propio eje o de su mesenterio; su cuadro clínico y hallazgos radiográficos son muy inespecíficos, por lo que requiere de un alto grado de sospecha para su diagnóstico y temprana resolución. Objetivo: Documentar y exponer nuestra experiencia con un caso de vólvulo intestinal en edad adulta y realizar una revisión bibliográfica actualizada sobre el diagnóstico y tratamiento de esta entidad. Exposición del caso: Paciente femenino de 74 años de edad con antecedentes de hipertensión arterial crónica, hipotiroidismo, cesárea y apendicectomía laparoscópica que presenta cuadro clínico de 3 días de evolución caracterizado por dolor abdominal, náuseas y vómitos. La tomografía computarizada con contraste muestra obstrucción intestinal a nivel de íleon por probable origen adherencial. Se realizó laparotomía exploratoria, se liberan adherencias ileo-ileales y se reduce vólvulo intestinal. Conclusiones: El vólvulo intestinal es una causa muy rara de abdomen agudo obstructivo cuyo diagnóstico clínico y radiológico es difícil. El tratamiento es quirúrgico para corregir el vólvulo y reestablecer la circulación, pero aún no se ha establecido cual es la mejor técnica quirúrgica.
