Diagnosis Of Small Bowel Volvulus Research Articles

An unusual presentation of small bowel volvulus: A case report

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.

The application of ultrasound in the diagnosis of small bowel volvulus in adults

Objective: To analyze the ultrasound characteristics of small bowel volvulus among adults and to investigate the value of ultrasound in the diagnosis of small bowel volvulus. Methods: Totally 34 adults with small bowel volvulus confirmed by clinical diagnosis or surgery and who underwent ultrasound examination at Peking Union Medical College Hospital from August 2017 to October 2022 were enrolled, including 19 males and 15 females, aged (55.0±21.8) years (range: 19 to 94 years). The clinical characteristics, CT images and ultrasound images of the patients were retrospectively reviewed, and the ultra, sound features of small bowel volvulus and its diagnostic efficacy were analyzed. Results: Abdominal pain was the typical clinical symptom of all patients. Other symptoms included 21 cases of abdominal distension, 19 cases of nausea and vomiting, and 13 cases of cessation of passage of stool or flatus. Eight patients had signs of peritonitis and 22 patients had abnormal bowel sounds. Twenty patients had a history of abdominal surgery. Twenty-seven patients underwent surgery for intestinal obstruction, and the remaining 7 patients improved after conservative treatment. All cases were evaluated by ultrasound, 11 cases showed a "whirl sign" and were diagnosed as small bowel volvulus, the diagnostic accuracy rate was 32.4% (11/34), ultrasound simultaneously diagnosed intestinal obstruction in 21 cases, 17 cases of abdominal effusion, 4 cases of intestinal wall thickening, 2 cases of abdominal mass, 1 case of intussusception, 1 case of right sided inguinal hernia. CT and ultrasound had a consistent positive discovery in 88.2% (30/34) of all the patients. Conclusion: Ultrasound is valuable in the diagnosis of small bowel volvulus and the evaluation of complications.

Total Small Bowel Volvulus on Incomplete Common Mesentery, an Exceptional Complication in Adults, Clinical Manifestation: A Case Report

Introduction: Incomplete common mesentery is the result of a rotational abnormality of the digestive tract. It is characterized by the persistence of an anatomical arrangement. Secondary to a rotational anomaly of the omphalo-mesenteric duct, thus constituting a meso common to the entire intestinal duct and an extremely short root of the mesenterium .These abnormalities of intestinal rotationcan lead to dreadful and sometimes fatal complications. The diagnosis of small bowel volvulus can be made in a wide variety of circumstances: acute intestinal occlusion, or even in shock. Repeated abdominal pain that can be associated with transit disorders. Case report: we report the observation of a 63 year old patient admitted for small bowel volvulus onincomplete common mesentery in whom the postoperative evolution wasfavourable. Conclusion: small bowel volvulus on incomplete common mesentery has a non-specific symptomatology; CT scan with contrast injection can confirm the diagnosis. Early intervention can be the one solution to treat this pathology.

Point-of-Care Ultrasonography as an Extension of the Physical Examination for Abdominal Pain in the Emergency Department: The Diagnosis of Small-Bowel Volvulus as a Rare Complication after Changing the Feeding Jejunostomy Tube.

Point-of-care ultrasonography (POCUS) has become the most popular modality of testing for physicians in recent years and is used for improving the quality of care and increasing patient safety. However, POCUS is not always acceptable to all physicians. To address the benefits and importance of POCUS, numerous studies have examined the use of POCUS in clinical practice and even medical education. This article aims to highlight the effects of POCUS as an extension of the physical examination, and we present a case to address the reasons it should be performed. For a man experiencing abdominal pain immediately after his feeding jejunostomy tube was changed, there was high suspicion of small-bowel volvulus after a “whirlpool sign” was observed during the POCUS, whereby mesenteric vessels presented in a whirling or spiral shape. This impression was subsequently confirmed by computed tomography. Small-bowel volvulus is a rare complication of changing a feeding jejunostomy tube. The images submitted here add to the sparse evidence from the literature on the use of POCUS as an extension of the physical examination for evaluating abdominal pain. POCUS can be used after taking the patient’s history and conducting a physical examination. The observation of a whirlpool sign may indicate the presence of a volvulus that is life-threatening.

Small bowel volvulus (SBV) in Northcentral Ethiopia

BackgroundSmall 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.MethodThe 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.ResultThere 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).ConclusionAnnual 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.

A rare case of secondary small bowel volvulus laparoscopically repositioned: literature review and classification

BackgroundSecondary small bowel volvulus is a rare condition caused by adhesions after laparotomy or tumors. There are no clear guidelines for indication of laparoscopic surgery.Case presentationA 69-year-old male visited our hospital complaining of epigastric pain. He had a history of hypopharyngeal carcinoma treated via pharyngolaryngoesophagectomy with restoration of esophageal continuity by harvesting a free jejunal autograft 6 years ago.Enhanced computed tomography revealed the whirl sign. An emergency laparoscopic operation was performed following a diagnosis of small bowel volvulus. This revealed rotation of the whole small bowel, involving the superior mesenteric artery as the center, and originating at the adhesion of the proximal and distal small bowel. Laparoscopic manipulation of volvulus and lysis of the adhesion were performed. The patient’s postoperative course was uneventful, and he was discharged on hospital day 5.ConclusionsLaparoscopic surgery may be useful for treating small bowel volvulus; however, the patient’s treatment indications should be judged carefully.

EP12.25: Fetal spontaneous resolution of small bowel volvulus: prenatal ultrasound and MRI diagnosis and neonate issue

The aim of these study was to describe the prenatal spontaneous resolution of small bowel volvulus using ultrasound and MRI examinations and the neonate outcome. A retrospective descriptive study was leaded in our university hospital centre during ten years. Inclusion criteria was fetal intestinal volvulus diagnosed by ultrasound and MRI with complete prenatal resolution. The ultrasound diagnosis was done using 2D and colour Doppler imaging. For each fetus prenatal ultrasound examination was completed by MRI. Ultrasound and MRI semiology were studied and compared. A weekly ultrasound fetal survey was performed. All the neonates had pediatric surgeon examination and an abdominal ultrasound scan was done. 3 fetuses were included. Mean gestational age of mid-gut volvulus diagnosis was 29.8 WG. The ultrasound imaging revealed only the 2D and colour Doppler “whirlpool sign”. The usual indirect ultrasound signs were not found in these three cases. The confirmation by MRI was effective in each case when winding dilated loops was highlighted. In our series no volvulus by intestinal malrotation was revealed. Antenatal outcome was spontaneous resolution with complete disappearance of the ultrasound sign of intestinal volvulus. Neonates outcome was normal with no intestinal complication found in all cases. Fetal ultrasonographic examination can done the diagnosis of small bowel volvulus. MRI is the exam which permit to confirm it. Spontaneous resolution of the fetal volvulus is possible and was described in three cases in our series of 13 prenatal cases of small bowel volvulus. The neonate prognosis was excellent.

Intestinal Volvulus: A Life-Threatening Disease.

A male infant was delivered at 40th week gestational age with a birth weight of 3.2 kilogram via cesarean section to a 29-year-old primiparous woman. The mother had normal antenatal care. The infant was admitted into neonatal intensive care unit with bilious vomiting and rectal bleeding at the age of 4 days. Physical examination revealed sick baby. He is tachycardiac (Heart rate: 170) and hypotensive (Blood pressure 45/20). There is abdominal distension, otherwise systemic examinations were normal. The baby was rapidly resuscitated with normal saline and intravenous antibiotics were started. Blood transfusion was given because hemoglobin dropped to 6.1 (normal value: 12. 2-15.3 gm/dL). An Upper Gastrointestinal Barium Swallow showed dilated duodenum (bold arrow) and “Corkscrew” of contrast projecting away from the posterior abdominal wall suspecting malrotation with midgut volvulus (narrow arrow) [Table/Fig-1]. [Table/Fig-1]: An Upper Gastrointestinal Barium Swallow showing dilated duodenum (bold arrow) and “Corkscrew” of contrast projecting away from the posterior abdominal wall suspecting malrotation with midgut volvulus (narrow arrow). An emergency laparotomy was performed, which confirmed twisting of superior mesenteric artery. Volvulus occurred at the duodenojejunal junction. There was 360 degree rotation of volvulus. The diagnosis of small-bowel volvulus was confirmed and Ladd’ procedure was performed [Table/Fig-2]. The bowel was not resected because of intestinal viability and no necrotic tissues in the second-look operation at 24 hours. [Table/Fig-2]: Twisting of superior mesenteric artery on laparotomy. During fetal development the intestinal volvulus is twisted because of malrotation of the intestine [1]. When the normal embryologic sequence of bowel development and fixation is interrupted, malrotation of the intestine occurs [1]. The pathogenesis of volvulus occurs because the narrow mesenteric base, which develops as a result of malrotation, allows the small bowel to twist around the superior mesenteric artery. This leads to vascular compromise of large portions of the midgut [1]. In neonates, malrotation with midgut volvulus classically presents with bilious vomiting and intestinal obstruction. Abdominal tenderness and hemodynamic deterioration (hematemesis, hematochezia and shock) are associated symptoms [2]. If the volvulus is missed, it can lead to vascular compromise, which can cause intraluminal bleeding evidenced by melena and/or hematemesis and worsening intestinal ischemia can lead to signs of shock [2]. The best diagnostic choice to diagnose malrotation, with or without midgut volvulus, is an upper GI series. The Ladd procedure remains the cornerstone of surgical treatment for malrotation [3]. Ladd procedure is described as reduction of volvulus (if present), division of mesenteric bands, placement of small bowel on the right and large bowel on the left of the abdomen. When intestinal malrotation is complicated by volvulus especially if the child has signs of systemic decompensation (hematochezia, abdominal distension, peritonitis and shock), it is a potentially life-threatening condition and requires emergent evaluation and treatment. The child should be rapidly resuscitated and immediately taken to surgery for exploration because quick surgical intervention, not prolonged medical management, is associated with the best results if midgut volvulus is suspected [3].

Intestinal volvulus. Case report and a literature review

Abstract Background Small bowel volvulus is a rare cause of intestinal obstruction in adult patients. This disease is more common in children and its etiology and management is different to that in adults. Clinical case A 30 year-old male with sarcoidosis presents with acute abdomen and clinical data of intestinal obstruction. Small bowel volvulus is diagnosed by a contrast abdominal tomography and an exploratory laparotomy is performed with devolvulation and no intestinal resection. In the days following surgery, he developed a recurrent small bowel volvulus, which was again managed with surgery, but without intestinal resection. Medical treatment for sarcoidosis was started, and with his clinical progress being satisfactory, he was discharged to home. Conclusions Making an early and correct diagnosis of small bowel volvulus prevents large intestinal resections. Many surgical procedures have been described with a high rate of complications. Therefore, conservative surgical management (no intestinal resection) is recommended as the best treatment with the lowest morbidity and mortality rate.

“Whirl” in the abdomen: Beware

This abdominal contrast-enhanced computed tomography (CECT) image of a 35-year-old gentleman with a 4-day history of abdominal pain shows the “whirl” sign characteristic of midgut volvulus (Fig. 1). Clinical examination was unremarkable except for tachycardia, and the abdomen was soft and nontender. There was no evidence of bowel wall ischemia, and flow in the mesenteric vessels was not compromised. A diagnosis of small bowel volvulus (midgut) should be suspected when pain is out of proportion to abdominal findings unlike pancreatitis and peritonitis where the abdomen is tender with or without guarding and rigidity. Other clinical features could include bilious vomiting, bloody diarrhea, chylous ascites, and malabsorption. If bowel wall ischemia and gangrene sets in, signs of peritonitis will be seen. Midgut volvulus is sometimes associated with Down’s syndrome, nonrotation or malrotation of midgut, cardiac and urogenital anomalies, diaphragmatic hernias, etc. Up to two-third of cases are reported in children less than 1 year of age with a slight male preponderance. As survival is inversely proportional to length of necrosed bowel, early recognition and intervention is important. This patient underwent Ladd’s procedure and had an uneventful recovery.

Multislice computed tomography angiography findings of chronic small bowel volvulus with jejunal diverticulosis

A volvulus, which is torsion of the bowel and its mesentery, is a medical emergency. Small bowel volvulus rarely occurs in adults, although it has been reported in the presence of small bowel diverticulum. Multislice computed tomography (CT) angiography, by demonstrating the mesenteric vessels, can be of help in the diagnosis of small bowel volvulus, especially when CT or gastrointestinal studies fail to show the diverticulum. We present the multislice CT angiography findings of a 64-year-old woman with chronic intermittent volvulus resulting from jejunal diverticulosis, surgically confirmed. To our knowledge, no similar case has been reported previously in the literature.

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.

Bowel Transition Points: Multiplicity and Posterior Location at CT are Associated with Small-Bowel Volvulus

To retrospectively evaluate the sensitivity and specificity of the number and location of bowel transition points at computed tomography (CT) in the diagnosis of small-bowel volvulus, with surgical findings as the reference standard. This HIPAA-compliant study had institutional review board approval; informed consent was waived. One hundred adult patients who had undergone preoperative CT and who had surgically proved non-abdominal wall hernia small-bowel obstruction (n=68) or small-bowel volvulus (n=32) were retrospectively identified. The patients included 61 women and 39 men with a mean age of 57 years (range, 18-96 years). One reader, blinded to the diagnoses, recorded the number of transition points at CT, the anteroposterior location of each transition point relative to the anterior edge of the spine, and the presence or absence of a whirl sign. Statistical analyses were performed with the Fisher exact test, unpaired t tests, and multiple logistic regression. The frequency of the finding of multiple transition points was significantly higher in patients with volvulus (19 [59%] of 32) than in patients without volvulus (11 [16%] of 68) (P<.001). Transition points associated with volvulus were less likely to be located more than 7 cm anterior to the spine (four [12%] of 32 patients) than were transition points not associated with volvulus (31 [46%] of 68 patients) (P<.005). The whirl sign was an additional significant independent predictor of volvulus (P<.05). When all three of these predictors were present, the specificity for small-bowel volvulus was 100%. The presence of multiple transition points with a posterior location at CT in an adult with small-bowel obstruction is significantly associated with volvulus.

Does the CT Whirl Sign Really Predict Small Bowel Volvulus?

The objective of this study was to determine the sensitivity of the CT "whirl sign" for the diagnosis of small bowel volvulus in patients who present with a clinical suspicion of intestinal obstruction. Between January 2002 and September 2004, 1,493 CT scans performed in 1,213 patients suspected of having small bowel obstruction were retrospectively reviewed by one attending radiologist with gastrointestinal subspecialization and one senior radiology resident. Multislice helical CT scans were performed after oral and intravenous contrast administration. All CT scans showing a combined vessel and bowel whirl appearance were identified. Other features recorded included the number of degrees of whirl rotation, direction of rotation, presence of bowel obstruction, and signs of ischemia. Diagnoses were determined at either surgery or clinicoradiographic follow-up. Surgical follow-up was available in 174 of the 1,213 patients. There were 460 males and 753 females ranging in age from 1 to 95 years (mean 59 years). A whirl sign was found in 33 of the 1,493 CT scans by reader 1 and in 13 of the 1,493 CT scans by reader 2. In 11 patients, surgery revealed small bowel volvulus (0.9%). Reader 1 detected 7 of the 11 volvuli (sensitivity 64%, specificity 98%, positive predictive value 21%, negative predictive value 99.7%). Reader 2 detected 3 of the 11 volvuli (sensitivity 27%, specificity 99%, positive predictive value 23%, negative predictive value 99.5%). The CT scans of the four remaining patients with volvulus not initially recognized by either reader were re-reviewed and were felt to contain whirl signs. Most patients with small bowel volvulus can be identified on CT through detection of a whirl sign. However, most whirl signs detected on CT will not prove to be indicative of small bowel volvulus.

A CASE OF SMALL BOWEL VOLVULUS DETECTED BY DIAGNOSTIC IMAGING, WHICH WAS USEFUL

An 83-year old woman was emeregently admitted to the hospital because of increasing low abdominal intermittent pain and fullness, which had occurred sometimes. There were no chracteristic findings in a plain abdominal X-ray film and ultrasonography. Abdominal CT demonstrated whirling mesentery adjacent to the mass with a calcification placed centrally, and a whirl-like pattern of the small bowel loops. In reviewing sagittal views of MRI, the patient was diagnosed as having a small bowel volvulus. A conservartive therapy was performed because no ischemic nor edematous changes were seen in the intestinal wall. But, whirl-like pattern did not disappear on CT even 10 days after the conservative therapy. and detorsion had to be performed operatively at laparotomy, it was found that the volvulus was twisted by 720° clockwise rotation around the mesenterium about 70cm from Treitz ligament to the ileo-cecal part. Abdominal CT and MRI are considered to be useful in the early diagnosis of small bowel volvulus. In this case, emergently operations were not necessarily needed under no inflammatory signs in the intestinal mucosa, even if a typical whirl-like pattern was demonstrated.