Presentation
Acute onset of abdominal pain 4 hours prior to presentation. Associated diaphoresis and vomiting.
Patient Data
Swirling of the vascular pedicle (superior mesenteric vein) concerning for volvulus with no bowel obstruction. Subsequent congestion of the mesentery. Minute amount of ascites.
Normal vascular relations between the superior mesenteric artery (SMA) and vein
(SMV). Normal location of the duodenojejunal junction on the left side. Those findings excludes the presence of intestinal malrotation.
Case Discussion
Midgut volvulus occurring in adults is a rare diagnosis, comprising 0.2-0.5% of cases. Usual presentation is of acute onset, non-specific abdominal pain, with or without gastrointestinal symptoms; however, presentation may be chronic, with the patient presenting intermittently with nausea, bloating, and abdominal pain following a meal 1.
In this case, the patient had been suffering from intermittent symptoms for months. CT was highly suggestive of volvulus yet with no signs of intestinal malrotation; however, the patient underwent a laparoscopy 18 hours following presentation, with no obvious hernia or adhesions to explain the CT findings. Of note there was chylous fluid in the RUQ and LLQ with chronically dilated small bowel loops in the LUQ. Given these findings, the patient was likely suffering from intermittent volvulus.
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