DOI: http://dx.doi.org/10.18203/2349-2902.isj20190409

Small bowel volvulus post gastric bypass

Baillie W. C. Ferris

Abstract


Small Bowel Volvulus (SBV) is an uncommon cause of Small Bowel Obstruction (SBO), which can be difficult to diagnose.  However, it is very important to recognise and intervene in a timely manner due to the high risk of bowel ischemia. Unfortunately, SBV does not always have clinical features that differentiate it from other causes of mechanical obstruction. The most reliable investigation appears to be Computed Topography (CT) scan with around 50% of patients displaying the classic ‘whirl’ sign on CT.  However, many remain undifferentiated SBO patients. Any of these patients who have any clinical or radiological suspicion of bowel ischemia, should be considered for surgery, as delays in diagnosis of bowel ischemia are associated with an increased risk of morbidity and mortality. In this case reported, author detailed a 55year female who presented with SBV had a CT scan which showed the classic ‘whirl’ sign and thus had timely surgical intervention and an uncomplicated recovery. Her history was significant for a subtotal colectomy, and a Rouxeny gastric bypass. This case highlights the importance of early recognition of SBV and also carries a reminder to consider rare causes of abdominal pain in patients who have had previous bariatric surgery. They have altered anatomy and thus are at increased risk of internal hernia and volvulus including SBV.


Keywords


Bariatric surgery, Bowel ischemia, Volvulus

Full Text:

PDF

References


Tjandra, J. Textbook of Surgery. 3rd ed. Blackwell; 2006: 159.

Li X, Zhang J, Li B, Yi D, Zhang C, Sun N, et al. Diagnosis, treatment and prognosis of small bowel volvulus in adults: a monocentric summary of a rare small intestinal obstruction. PLos One. 2017;12(4):e0175866.

Roggo A, Ottinger LW. Acute small bowel volvulus in adults. a sporadic form of strangulating intestinal obstruction. Ann Surg. 1992;216(2):135.

Valsdottir E, Marks JH. Volvulus: small bowel and colon. Clin Colon Rectal Surg. 2008;21(2):91.

Thornton SC, Pal N. Sigmoid and caecal volvulus, 2016. Available at: https://emedicine.medscape.com/article/2048554-overview. Accessed 17 January 2017.

Lepage-Saucier M, Tang A, Billiard JS, Murphy-Lavallée J, Lepanto L. Small and large bowel volvulus: clues to early recognition and complications. Euro J Radiol. 2010;74(1):60-6.

Ruiz-Tovar J, Morales V, Sanjuanbenito A, Lobo E, Martinez-Molina E. Volvulus of the small bowel in adults. Am Surg. 2009;75(12):1179-82.

Duke JH, Yar MS. Primary small bowel volvulus: cause and management. Arch Surg. 1977;112(6):685-8.

Shah, V. Gillard, F. Intestinal Ischemia. Available at: https://radiopaedia.org/articles/intestinal-ischaemia. Accessed 20 November 2018.

Bakker JK, Namen YB, Bruin SC, Brauw LM. Gastric bypass and abdominal pain: think of Petersen hernia. JSLS. 2012;16(2):311.

Ferris BW. Gastric volvulus post sleeve gastrectomy converted to gastric bypass in pregnancy: a case report. Int Surg J. 2018;5(11):3754-6.