A CASE OF SMALL BOWEL VOLVULUS PROBABLY CAUSED BY A MESENTERIC CYST IN AN ADULT

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  • OKADA Ken-ichi
    Department of Gastroenterological Surgery, Tokai University School of Medicine
  • SADAHIRO Sotaro
    Department of Gastroenterological Surgery, Tokai University School of Medicine
  • ISHIKAWA Kenji
    Department of Gastroenterological Surgery, Tokai University School of Medicine
  • SUZUKI Toshiyuki
    Department of Gastroenterological Surgery, Tokai University School of Medicine
  • MAKUUCHI Hiroyasu
    Department of Gastroenterological Surgery, Tokai University School of Medicine

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  • 腸間膜嚢胞により誘発されたと考えられる成人小腸軸捻転症の１例

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Abstract

Secondary volvulus of the small intestine is a rare entity and most cases are caused by malrotation or adhesion. This time we experienced a case of small bowel volvulus probably caused by a mesenteric cyst.<br> A 67-year-old woman complaining of the sudden onset of severe abdominal pain after dinner was found to have severe tenderness of the diffusely distended abdomen with peritoneal sign. Plain X-ray of the abdomen showed multiple air-fluid levels in the dilated small intestine. Abdominal CT scan showed a “whirl sign” in the small intestine loops around the superior mesenteric artery and a fist-sized cystic tumor. Emergency laparotomy conducted 5 hours after the onset under a diagnosis of strangulation ileus with mesenteroaxic torsion revealed no ischemic changes on the bowel twisted clockwise by 900°, and a fist-sized mesenteric cyst several centimeter caudal side from the volvulus. The cyst might cause the volvulus. After detorsion, the mesenteric cyst was resected without bowel resection. The resected material was a 95×75mm unilocular cyst. The histopathological diagnosis was mesenteric cyst. The patient was discharged from the hospital on the 8th postoperative day. There have been no signs of recurrence as of 9 months after the operation.<br> Reports of secondary small bowel volvulus in adults are few. Abdominal CT is thus useful in early diagnosis.

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