Small bowel volvulus

Case contributed by Dr Michael P Hartung


Sudden onset of nausea, vomiting, abdominal pain.

Patient Data

Age: 70
Gender: Female

The stomach, duodenum, and jejunum are dilated and filled with fluid/oral contrast. The small bowel abruptly transitions in mid-abdomen with a "swirled appearance". Distally to the point of volvulus, there is a long segment of small bowel in the mid abdomen which is dilated, mildly thickened/irregular, and slightly hyperenhancing. However, this segment of bowel gradually transitions into normal caliber distal small bowel, without another point of obstruction. 

Case Discussion

Classic case of small bowel volvulus. At surgery, two adhesive bands were felt responsible for the volvulus (from the op-note):

"Midportion of the ileum was adhered deeply to the posterior wall of the abdomen which was causing a volvulus. These 2 bands of adhesions were transected and the bowel was freed"

Usually, the swirled appearance or "whirlpool" sign is most evident in one projection, so it's very important to at least review the bowel in axial and coronal reformats. 

What makes this case interesting is not only the volvulus, but also the abnormal appearance of the bowel distal to the volvulus. The jejunal and ileal branches supplying this segment are involved in volvulus (best seen on the axial images), and as a result bowel perfusion is abnormal. However, the ileocoloic branches are not involved, and you can see the vessels coursing to the right of the volvulus. Therefore, the distal ileum and right colon supplied by these vessels looks normal. These findings make for a nice review of vascular anatomy/distribution, and just a little extra digging and knowledge makes for a very cohesive case. 

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Case information

rID: 57809
Case created: 14th Jan 2018
Last edited: 9th Mar 2018
Inclusion in quiz mode: Included

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