Presentation
Tachycardia, lower extremity swelling.
Patient Data
Hepatic steatosis.
Dilated duodenum with oral contrast, which compresses the IVC. Clockwise twisting at the duodenal-jejunal junction about 360 degrees, resulting in luminal narrowing but no obstruction as contrast has passed distally. Adjacent minimal fluid/stranding and mildly congested mesenteric nodes.
A large SMV varix bypasses the resultant venous narrowing, meandering through the right abdomen.
Redundant but normally positioned large bowel.
Yellow arrows indicate the large SMV varix bypassing the narrowing.
Red arrow indicates the narrowed IVC due to the dilated duodenum.
Case Discussion
Unusual case of chronic small bowel volvulus with narrowing but no obstruction. The patient presented with lower extremity swelling and tachycardia, presumably a result of chronic venous congestion, and surprisingly because the dilated duodenum compresses the IVC (annotated image).
Chronic volvulus can be concluded by the lack of obstruction, compensatory enlargement of the duodenum, and because a large meandering varix bypasses the narrowing/twisting of the SMV.
Unable to process the form. Check for errors and try again.