[Small bowel volvulus due to a giant mesenteric lipoma]. / Zavorot tonkoi kishki, obuslovlennyi gigantskoi lipomoi bryzheiki.

Mesenteric lipomas are very rare. They are asymptomatic in most cases, but some patients can develop certain complications such as small bowel volvulus and acute small bowel obstruction. We report a 78-year-old patient with giant mesenteric lipoma complicated by jejunum volvulus and acute small bowel obstruction. The patient underwent laparotomy, en-bloc resection of small bowel, mesentery and lipoma followed by side-to-side anastomosis.

Small bowel volvulus (SBV) in Northcentral Ethiopia.

BACKGROUND: Small bowel volvulus (SBV) is a benign gastrointestinal surgical condition in which there is a torsion of all or parts of a segment of small bowel on its mesenteric axis. It has been contributed significant burden of surgical emergency as cause of small bowel obstruction in developing countries. The main objective this study was to explore clinical and epidemiological profile of Small bowel volvulus in Northcentral Ethiopia. METHOD: The study was conducted at Debre Tabor General Hospital, South Gondar in Northcentral Ethiopia. The medical records of patients with a discharge diagnosis of small bowel volvulus were reviewed. The patients were seen for a 4-year period from Jan1, 2016-Dec31, 2019. The study was hospital-based retrospective cross-sectional and data were collected with a standardized structure questioner tool. The collected data checked for any inconsistency, code, and enter SPSS version 23 for data processing and analysis. Descriptive analyses were represented as frequency, percent, mean ± standard deviation for normal distribution, and Median ± Interquartile range for skewed data. Cross tabulation analysis was done for risk factors contributed for mortality and morbidity of SBV. RESULT: There were 148 patients with Small bowel volvulus as a cause of small bowel obstruction was admitted within 4 years. The annual occurrence rate was 35cases per year. It represented 59% of small bowel obstruction and 36.3% of bowel obstruction. The majority were males (N = 125, 84.5%) and females were (N = 23, 15.5%). The age ranged from 15 to 78 years. The mean age was 41.14 ± (SD = 15.4). The most common clinical presentation was abdominal pain 98% and vomiting 91.2%. The median time of hospital stay was 5 days (± IQR = 2). The mean duration of illness before hospital admission was 2 days (± SD = 1.4) and median was 1 day (± IQR = 2). The morbidity rate was 5.4% (N = 8) and the mortality rate was 3.4%(N = 5). CONCLUSION: Annual occurrence of SBV was 37 cases per year. The prevalence of SBV was 59% of small bowel obstruction and 36.3% of bowel obstruction respectively.

Volvulus of the entire small bowel with normal bowel fixation simulating malrotation and midgut volvulus.

BACKGROUND: Midgut volvulus is a complication of malrotation of bowel and mesenteric malfixation. In contrast, primary volvulus of the small bowel is a distinctly different and rare entity characterized by torsion of the entire small bowel with normal mesenteric fixation. OBJECTIVE: To present the clinical and imaging findings in four infants with primary small bowel volvulus and normal bowel fixation in order to improve awareness of this entity among clinicians and radiologists and to discuss the potential etiologies of this entity to distinguish it from other causes of small bowel volvulus. MATERIALS AND METHODS: A retrospective review of imaging studies (two ultrasounds and four upper gastrointestinal series) in four infants (three full-term and one premature) from three institutions with surgically proven volvulus of the entire small bowel and normal bowel fixation were reviewed by three board-certified pediatric radiologists and correlated with clinical and surgical reports when available. RESULTS: The infants presented during the first week to 6 months of life and were acutely ill. The upper gastrointestinal series showed complete duodenal obstruction with beaking in one and partial duodenal obstruction in three. All studies were interpreted as highly suspicious for malrotation and midgut volvulus. Emergent laparotomy demonstrated primary small bowel volvulus with normal mesenteric fixation in all infants. The base of the small bowel mesentery was described by the operating surgeon as smaller than normal in one infant (case 3). There was no mesenteric defect or other abnormality predisposing to volvulus in the other three. In both infants who had abdominal US, a retroperitoneal position of the third portion of the duodenum was demonstrated. All infants survived. One infant required resection of the necrotic small bowel and currently has short gut syndrome, one has malabsorption and two were lost to follow-up. CONCLUSION: Primary small bowel volvulus with normal fixation is indistinguishable from malrotation with midgut volvulus in the acutely ill infant or child. Radiographic diagnosis can be difficult in patients with intermittent or incomplete small bowel volvulus without malrotation. In these patients, neither an upper gastrointestinal series demonstrating a normal position of the duodenojejunal junction nor the sonographic demonstration of a retromesenteric third portion of the duodenum excludes the diagnosis. In young infants, the clinical and imaging findings may mimic necrotizing enterocolitis. Sonography may be useful to evaluate the bowel for signs of bowel wall compromise or a whirlpool sign.

[Gastrointestinal tract volvulus: diagnosis and correlation between plain-film X-ray and multidetector computed tomography findings]. / Vólvulos del tracto gastrointestinal. Diagnóstico y correlación entre radiología simple y tomografía computarizada multidetector.

Gastrointestinal volvuli cause processes that manifest as acute abdomen. Volvuli are important not because they are common, but rather because their possible complications can be severe. All types of volvuli share a common pathophysiology, which consists of intestinal obstruction in a closed loop that results in ischemia. The clinical manifestations are nonspecific, so radiologists play a very important role in the early identification of the most common signs of torsion. These include the "bird's beak sign", the "whirlpool sign", and signs of potentially reversible or irreversible ischemia. The treatment of choice in most cases is surgery, either to correct the torsion and save the organ or to resect it if it is necrotic.

Small bowel volvulus with chylous ascites: a case report.

Here, we report a rare case of small bowel volvulus with chylous ascites. A 93-year-old man with a medical history of angina pectoris presented to the emergency department with abdominal pain. Computed tomography revealed a whirl sign of the mesenteric vessels with the axis of the superior mesenteric artery. A diagnosis of small bowel volvulus was made, and emergency surgery was performed. Laparoscopic examination revealed chylous ascites. Due to severe intestinal edema and difficulty in manipulating the forceps, surgery was transferred to a laparotomy. The entire small bowel was twisted 360° counterclockwise, requiring manual untwisting. Examination of the intestinal tract after untwisting revealed no evidence of ischemia or necrosis. However, because a diverticulum was observed on the mesenteric side of the upper jejunum and considering the influence of secondary small bowel volvulus, partial small bowel resection was performed. The patient had a favorable postoperative course.

Small bowel volvulus associated with percutaneous endoscopic gastrojejunostomy tube: A case report.

INTRODUCTION: Percutaneous endoscopic gastrojejunostomy (PEG-J) is a convenient and safe enteral feeding tool for patients with oropharyngeal dysfunction accompanied by gastroesophageal reflux. However, serious complications have not been fully characterized. PRESENTATION OF CASE: A 22-year-old man with cerebral palsy was referred to our department with complaints of vomiting and massive bloody stools for 10 h. On imaging examination, strangulated bowel obstruction due to the PEG-J tube was suspected because the tube was located on the right side of the body, and the small intestine was diffusely dilated with a reduced wall contrast effect. Urgent laparoscopy revealed a small bowel volvulus (SBV) twisted 180° clockwise around the superior mesenteric artery, which was repaired manually without intestinal resection. The patient was treated in the intensive care unit postoperatively but required partial ileal resection and colostomy owing to the difficulty in managing watery diarrhea and intestinal infection. The patient was discharged after stoma closure 121 days after initial surgery. DISCUSSION: Although SBV rotated at the site of PEG insertion has been reported as a rare complication, there are no reports of rotation of the PEG-J tube itself associated with SBV. In the present case, abnormal positioning of the PEG-J tube on imaging was helpful for diagnosis. CONCLUSION: SBV should be recognized as a potential complication of PEG-J, since delayed diagnosis can lead to irreversible ischemia of the extensive small intestine.

Acute Primary Small Bowel Volvulus in a Male With Loeys-Dietz Syndrome.

Loeys-Dietz syndrome (LDS) is a connective tissue disorder with features including, but not limited to, aortic dissections, skeletal abnormalities, and craniofacial defects. However, considering its relatively recent discovery, there are still many unknowns about LDS. The extent of a connective tissue disorder like LDS is yet to be defined throughout the various organ systems, including the gastrointestinal system. Connective tissue disorders have been found to have higher associations with certain conditions, like constipation. In a similar manner, LDS may increase the propensity for developing uncommon gastrointestinal manifestations, like primary small bowel volvulus. A volvulus is defined as an abnormal rotation of the small bowel segment along the axis of its mesentery. Primary small bowel volvulus is differentiated from secondary small bowel volvulus by its nature of origin: primary small bowel volvulus occurs as an independent spontaneous occurrence, whereas secondary small bowel volvulus is secondary to the presence of adhesions, diverticular disease, or abdominal masses. In this case report, we highlight a potential gastrointestinal manifestation of LDS with the occurrence of a primary small bowel volvulus in a young adult male diagnosed with LDS. The patient experienced acute primary small bowel volvulus 14 days into his stay, which may have been influenced by this newfound connective tissue disorder.

Acute Chyloperitoneum with Small Bowel Volvulus: Case Series and Systematic Review of the Literature.

Introduction: Chyloperitoneum arises from lymph leakage into the abdominal cavity, leading to an accumulation of milky fluid rich in triglycerides. Diagnosis can be challenging, and mortality rates vary depending on the underlying cause, with intestinal volvulus being just one potential acute cause. Despite its rarity, our case series highlights chyloperitoneum associated with non-ischemic small bowel volvulus. The aims of our study include assessing the incidence of this association and evaluating diagnostic and therapeutic approaches. Material and Methods: We present two cases of acute abdominal peritonitis with suspected small bowel volvulus identified via contrast-enhanced computed tomography (CT). Emergency laparotomy revealed milky-free fluid and bowel volvulus. Additionally, we conducted a systematic review up to 31 October 2023, identifying 15 previously reported cases of small bowel volvulus and chyloperitoneum in adults (via the PRISMA scheme). Conclusions: Clarifying the etiopathogenetic mechanism of chyloperitoneum requires specific diagnostic tools. Magnetic resonance imaging (MRI) may be useful in non-emergency situations, while contrast-enhanced CT is employed in emergencies. Although small bowel volvulus infrequently causes chyloperitoneum, prompt treatment is necessary. The volvulus determines lymphatic flow obstruction at the base of the mesentery, with exudation and chyle accumulation in the abdominal cavity. Derotation of the volvulus alone may resolve chyloperitoneum without intestinal ischemia.

Primary Midgut Volvulus: An Unusual Case of a Young Adult Necessitating Extensive Bowel Resection.

Primary small bowel volvulus (SBV), commonly known as midgut volvulus, is an uncommon condition in which the small intestine rotates around its own mesenteric axis. This case report details the diagnostic and management challenges encountered in a rare presentation of primary SBV in a previously healthy 19-year-old male. Our patient presented with acute abdominal pain, vomiting, and signs of shock, prompting urgent medical attention. He was sent for exploratory laparotomy and underwent extensive resection of the gangrenous bowel. Diagnosis involved an abdominal computed tomography scan revealing the characteristic "whirl sign." According to the World Society of Emergency Medicine, surgical intervention should be done to address the SBV through resection of the gangrenous bowel segments. Despite efforts, the patient's prognosis remained guarded, necessitating ongoing supportive measures. This case highlights the complex challenges associated with primary SBV, emphasizing the need for continued research to enhance diagnostic precision and refine management strategies.

Adult Mesenteric Lymphangioma Resulting in Small Bowel Obstruction.

A mesenteric cystic lymphangioma (MCL) is a rare condition that primarily manifests in children. This case report illustrates an unusual presentation of an MCL causing a small bowel obstruction with volvulus in an adult. We present a 31-year-old male who presented to our hospital with a small bowel obstruction. He underwent laparotomy, and a lymphatic mass acting as a lead point and causing small bowel volvulus was discovered intra-operatively. The patient underwent a small bowel with associated mass resection and primary anastomosis; he recovered well. The final pathology demonstrated an MCL. Despite the MCL being a rare entity in adults, it must be considered as the differential for various abdominal pathologies. Although the majority of these masses lack malignant potential, they should be resected, as they pose a risk of mechanical obstruction, torsion, and perforation. Prior descriptions include individual case reports of symptomatic lesions, proposed non-operative management, and follow-up imaging.

Spontaneous small bowel volvulus in young adult male.

Small bowel volvulus is a rare surgical pathology in western countries with a rather misunderstood pathophysiology. This condition refers to the abnormal torsion of the small bowel loops on its mesenteric axis and blockage of the mesenteric vessels, thus leading to bowel obstruction. Typical symptoms include abdominal pain and distention, vomiting and bloody stools. Volvulus can also cause ischemia due to a compromised blood supply. Small bowel volvulus can be life-threatening and require immediate surgery. In this case report, we present a 28-year-old male patient who was admitted to the emergency department with significant, unrelenting abdominal pain and vomiting with no blood. CT scan identified small bowel volvulus and torsion of the mesentery. The biopsy report confirmed no malignancy in this patient. The patient underwent surgery and was discharged 2 days later.

Idiopathic sclerosing mesenteritis presenting with small bowel volvulus in a patient with antiphospholipid syndrome: A case report.

BACKGROUND: Sclerosing mesenteritis is a rare disorder involving inflammation of the mesentery. Its etiology remains unclear, but it is believed to be associated with previous abdominal surgery, trauma, autoimmune disorders, infection, or malignancy. Clinical manifestations of sclerosing mesenteritis are varied and include chronic abdominal pain, bloating, diarrhea, weight loss, formation of an intra-abdominal mass, bowel obstruction, and chylous ascites. Here, we present a case of idiopathic sclerosing mesenteritis with small bowel volvulus in a patient with antiphospholipid syndrome. CASE SUMMARY: A 68-year-old female presented with recurrent small bowel obstruction. Imaging and pathological findings were consistent with sclerosing mesenteritis causing mesenteric and small bowel volvulus. Computed tomography scans also revealed pulmonary embolism, and the patient was started on a high dose of corticosteroid and a therapeutic dose of anticoagulants. The patient subsequently improved clinically and was discharged. The patient was also diagnosed with antiphospholipid syndrome after a hematological workup. CONCLUSION: Sclerosing mesenteritis is a rare condition, and patients with no clear etiology should be considered for treatment with immunosuppressive therapy.

An Internal Hernia With Small Bowel Volvulus From an Inferior Vena Cava Filter Wire Strut: A Rare Cause of Acute Abdomen.

The use of inferior vena cava (IVC) filters has been increasingly prevalent. Although they are relatively safe with clear indications, they are not without complications. Late-onset complications include IVC filter migration, IVC wire fracture, wire strut penetration, and perforation of organs in its vicinity. In this report, we present the case of a patient with small bowel volvulus secondary to an IVC wire strut migration, causing tethering of the mesentery and vascular compromise to the small bowel.

Small Bowel Volvulus Complicated by Bowel Infarction.

Teaching Point: Torsion of a segment of the small bowel and its mesentery, together with closed loop obstruction and absent enhancement of paper-thin small bowel walls, is an alarm sign for small bowel volvulus complicated by acute bowel infarction.

Mesenteric lipoma with small bowel volvulus: A rare cause of upper gastrointestinal obstruction (a case report and literature review).

INTRODUCTION: Small bowel volvulus due to mesenteric lipoma is a rare clinical entity. It poses both a diagnostic and therapeutic challenge. Small bowel mesenteric lipoma is a rare cause of small bowel obstruction. We present the case of a patient admitted to our emergency department for a small bowel volvulus due to a mesenteric lipoma with small intestine obstruction. PATIENT AND METHOD: A 61 years old man, with diabetes since 25 years with antidiabetics oral medication, vaccinated against Covid 19 (two doses) who presented with peri-umbilical pain for two months, constipation and melaena, complicated 3 days before his admission by obstructive symptoms and vomiting with apyrexia and overall health state alteration. The physical examination noticed abdomen distension and the abdominal CT scan revealed a large fatty mass of the hypochondrium and left flank, roughly oval with regular borders, well limited measuring 124 × 86 mm of height of 126 mm thought to be a liposarcoma. The patient underwent enbloc resection of 20 cm of small bowel with the mass and end to end anastomosis of the ileo-ileum. The postoperative course was uneventful and he was been discharged from hospital on day 5. DISCUSSION: Mesenteric lipomas are diagnosed incidentally after laparoscopy or laparatomy. Ultrasound shows a well defined homogenous echogenic mass, and so can distinguish it from a mesenteric cyst. Computed Tomography (CT) is the standard imaging of diagnosis and shows homogenous tumor of adipose tissue. The treatment is surgery and the prognosis is better. CONCLUSION: The mesenteric is an uncommon location of lipoma. When there is small bowel obstruction with intra-abdominal mass, the mesenteric lipoma could be recalled.

Ileo-sigmoid knotting in a female Ethiopian patient, a case report.

INTRODUCTION: Ileo-sigmoid knotting is a very rare cause of bowel obstruction. The diagnosis can be challenging and may not be suspected pre-operatively. A high index of suspicion, especially in areas of the "sigmoid belt" region, can be helpful. CASE PRESENTATION: A 40-year-old ethnic Amhara female patient presented with symptoms and signs of bowel obstruction. She presented in shock and after resuscitation, laparotomy revealed gangrenous ileum twisted around the sigmoid colon ('ileo-sigmoid knotting'). The gangrenous ileal segment was resected, with end-to-end ileo-ileal anastomosis. The patient had a smooth postoperative course and was discharged on the 4th post-operative day. CONCLUSIONS: Twisting of the ileum around the sigmoid colon is pathognomonic of ileo-sigmoid knotting. Prompt resuscitation and surgical intervention in the shocked patient with an acute abdomen and evidence of intestinal obstruction could be life-saving.

Seasonality of Primary Small Bowel Volvulus and Its Variations Based on Sex and Place of Residence, North Western Ethiopia.

Background Primary small bowel volvulus is a common surgical emergency in some parts of the globe. Its seasonal nature has not been widely researched. The main objective of this study was to assess its underlying patterns among different gender and geographical location. Materials and methods A hospital-based retrospective cross-sectional study was conducted from November 2020 to February 2021 at two comprehensive specialized hospitals in North West Ethiopia. The monthly count of primary small bowel volvulus was analyzed for patterns using Minitab 18. Graphical techniques such as run sequence plots, multiple box plots, and correlogram were used. Additive decomposition was also done. The degree of seasonal variation was measured in terms of seasonal indices generated for each month. A chi-square goodness-of-fit test at p < 0.05 was applied to determine statistical significance. Results A total of 235 patients were found to have surgically confirmed diagnosis of primary small bowel volvulus over six years. Most were males (77.4%) and from rural residence (73.2%). The mean age in years was 40.5 (±16.7). Overall, 179 (76.2%) of the total cases, 148 (81.3%) of males, and 138 (80.2%) of rural cases were admitted during June through November. Conclusion Seasonal variation was found to be a feature of primary small bowel volvulus. Knowing its seasonal nature helps raise the threshold of suspicion among health care providers to pass timely clinical decisions particularly in resource-limited setups.

Jejunal volvulus within an inguinal hernia sac like as an extremely rare cause of acute mechanical gastrointestinal obstruction in adults: First literature report.

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.

Gastric Signet Ring Cell Adenocarcinoma Presenting as Intermittent Volvulus of Small Bowel: A Case Presentation and Review of the Literature.

Signet ring cell carcinoma (SRCC) is an uncommon and poorly differentiated tumor. It arises mostly in the gastrointestinal tract. The incidence of gastric SRCC has increased in the past few years. Volvulus is the twisting of the bowel around its mesentery. It is classified as either primary or secondary. It is relatively common in the cecum and sigmoid colon. Volvulus of other parts of the gastrointestinal tract is relatively rare. Herein, we present a case of small bowel volvulus (SBV) secondary to advanced gastric SRCC with peritoneal carcinomatosis. The patient had presented with nausea and vomiting. Initial computed tomography (CT) scan of abdomen unveiled jejunal volvulus. SBV resolved spontaneously on a repeat CT scan. Enteroscopy with histopathology confirmed the diagnosis of gastric SRCC, which turned to be metastatic to peritoneum on laparoscopy. We believe our case is unique due to the rarity of advanced gastric SRCC presenting as secondary jejunal SBV without appreciated gastric mass on imaging.

Primary small bowel volvulus: A case report and literature review.

Background: Small bowel volvulus (SBV) is an aberrant rotation of the small bowel segment along the axis of its mesentery.Secondary SBV is the most frequent situation. Postoperative adhesions represent the main cause. On the other hand, primary SBV is an extremely rare situation. There are no predisposing anatomical abnormalities.Herein, we present a case of a 73-year-old-patient, with no surgical history, presenting primary SBV. Case presentation: A 73-year-old-patient presented to the emergency department with a one-day history of acute abdominal pain and vomiting. He had no medical comorbidities and no previous abdominal surgery.On examination, he was agitated and afebrile.Urgent computed tomography (CT) scan showed dilated small bowel loops with a "whirl sign".A laparotomy was performed. It revealed a 320° SBV of the distal jejunum and the proximal ileum. The small bowel was ischemic. There were no congenital malformations, no adhesions, and no internal hernia.We performed a detorsion of the small bowel. It regained good vitality. To avoid recurrence, we performed enteropexy of the terminal ileum, and the caecum to widen the mesenteric base.We noted no recurrence of the pathology after three months of follow-up. Conclusion: Primary SBV is an extremely rare situation. Physiopathology is still misunderstood. The clinical presentation is not specific. Diagnosis can be evoked by CT scan but can only be confirmed intraoperatively. The surgical treatment should be performed timely. Different techniques have been described to avoid recurrence. None of those techniques is consensual.