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Medical City Arlington
intestinal volvulus, intestinal obstruction
Digestive System Diseases | Internal Medicine | Pathological Conditions, Signs and Symptoms
Introduction and Case Presentation: We report an unusual case of an adult midgut volvulus presenting first as a transverse colon volvulus. A 62-year-old man with no significant past medical history presented to the emergency department with complaints of intractable nausea, vomiting, and abdominal pain for twenty-four hours. He had been evaluated at an outside hospital where an abdominal and pelvis computed tomography was read as a transverse colon volvulus, a vanishingly rare medical condition. A CT reimaging of the abdomen and pelvis illustrated a whirlpool sign in the region of the small bowel, consistent with a small bowel volvulus. In the emergency department, his blood pressure was 143/79 and his heart rate was 58. His physical exam showed abdominal tenderness to palpation. Pertinent labs include blood urea nitrogen of 26 mg/dL and a creatinine of 2.1 mg/dL. The patient underwent exploratory laparotomy. Operative findings revealed a loop of jejunum that was adhered down to the anterior pelvis wall along a previous peritoneal flap dissection. This created an internal hernia with multiple loops of small bowel that were herniated underneath. It is surmised that that loop of jejunum and internal hernia created the small bowel volvulus and, hence, the rare “whirlpool sign” on the CT scan. No other evidence was identified of any small bowel pathology that could have caused any of the patient’s symptoms. After the loop of jejunum was lysed the patient recovered without any more symptoms and was able to return home. Learning Points: This case conveys that a volvulus can be something ephemeral that may resolve after showing characteristic signs of its presence in imaging and causing its characteristic symptoms in patients.
HCA Healthcare Graduate Medical Education
Walworth, Allison and Ford, Danielle, "An Interesting Twist: An Adult Midgut Volvulus Presenting as a Transverse Colon Volvulus, Both Rare Phenomena" (2023). North Texas Research Forum 2023. 21.