Jennifer M. Kolb from the Icahn School of Medicine at Mount Sinai in New York shares this video case “Small-intestinal volvulus after subtotal colectomy visualized during colonoscopy.”
We present an unusual case of a 61-year-old female with chronic intermittent abdominal pain and distension months after laprascopic cholecystectomy and subtotal colectomy with ileosigmoid anastamosis. Colonoscopy revealed patent anastamosis and CT was nondiagnostic. The patient was instructed to take a solid meal to produce symptoms and soon after an unprepped, unsedated colonoscopy was pursued. At this time, an actively twisting small intestinal volvulus was seen just proximal to the anastamosis. With the culprit of her symptoms discovered, the patient was sent for small bowel resection that resolved her discomfort and improved her quality of life.
This video captures a small intestinal volvulus, a rare and interesting finding that may underlie explained abdominal pain and distension in post surgical patients. The endoscopic appearance of a small bowel volvulus with a “whirl” or “tornado” sign at the point of the twist, collapsed distal segment, and dilated fluid filled proximal segment mirror the findings in colonic volvulus.
This case teaches that unorthodox diagnostic strategies such as imaging after a provocative meal my be helpful.
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