VIDEOGIE Todd H. Baron, MD, G. S. Raju, MD, Editors for VideoGIE
Small-intestinal volvulus after subtotal colectomy visualized during colonoscopy
Figure 1. A small intestinal volvulus just proximal to the ileosigmoid anastomosis.
We present an unusual case of unexplained chronic intermittent abdominal distension and pain months after subtotal colectomy. Symptoms were increased by eating and improved by bowel movements produced after postural maneuvers. Colonoscopy after 24 hours of liquid diet and standard bowel preparation revealed patent anastomosis and no other abnormalities. CT was nondiagnostic. We proceeded with an unprepped, unsedated colonoscopy, instructing the patient to take a solid meal 2 hours before the procedure to produce symptoms. A smallintestinal volvulus was seen just proximal to the ileosigmoid anastomosis (Fig. 1; Video 1, available online at www.giejournal.org). The endoscopic appearance of small-bowel volvulus (the “whirl” or “tornado” sign at the point of the twist, collapsed distal segment, and dilated, flaccid, fluid-filled proximal segment) mirrored the findings in colonic volvulus. Laparoscopy with small-bowel resection resulted in marked improvement in symptoms
www.giejournal.org
and quality of life. Although rare, chronic small-intestinal volvulus may underlie unexplained abdominal pain and distension in a post-subtotal colectomy setting. Unorthodox diagnostic strategies such as imaging after a provocative meal may be helpful. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Jennifer M. Kolb, MD, Barry Salky, MD, James Aisenberg, MD, Icahn School of Medicine at Mount Sinai, New York, New York, USA
http://dx.doi.org/10.1016/j.gie.2014.03.034
Volume
-,
No.
-
: 2014 GASTROINTESTINAL ENDOSCOPY 1
Small-intestinal volvulus after subtotal colectomy visualized during colonoscopy
Figure 1. A small intestinal volvulus just proximal to the ileosigmoid anastomosis.
We present an unusual case of unexplained chronic intermittent abdominal distension and pain months after subtotal colectomy. Symptoms were increased by eating and improved by bowel movements produced after postural maneuvers. Colonoscopy after 24 hours of liquid diet and standard bowel preparation revealed patent anastomosis and no other abnormalities. CT was nondiagnostic. We proceeded with an unprepped, unsedated colonoscopy, instructing the patient to take a solid meal 2 hours before the procedure to produce symptoms. A smallintestinal volvulus was seen just proximal to the ileosigmoid anastomosis (Fig. 1; Video 1, available online at www.giejournal.org). The endoscopic appearance of small-bowel volvulus (the “whirl” or “tornado” sign at the point of the twist, collapsed distal segment, and dilated, flaccid, fluid-filled proximal segment) mirrored the findings in colonic volvulus. Laparoscopy with small-bowel resection resulted in marked improvement in symptoms
www.giejournal.org
and quality of life. Although rare, chronic small-intestinal volvulus may underlie unexplained abdominal pain and distension in a post-subtotal colectomy setting. Unorthodox diagnostic strategies such as imaging after a provocative meal may be helpful. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Jennifer M. Kolb, MD, Barry Salky, MD, James Aisenberg, MD, Icahn School of Medicine at Mount Sinai, New York, New York, USA
http://dx.doi.org/10.1016/j.gie.2014.03.034
Volume
-,
No.
-
: 2014 GASTROINTESTINAL ENDOSCOPY 1
