[Primary Volvulus of the Small Intestine Mimicking Nonocclusive Mesenteric Ischemia Following Open-heart Surgery]

Kyobu Geka. 2022 Sep;75(9):663-666.
[Article in Japanese]

Abstract

A 73-year-old female who underwent aortic valve replacement with a biological valve, coronary artery bypass, and left atrial appendage closure had sudden onset of nausea and abdominal pain 43 days after surgery. She had a history of nonocclusive mesenteric ischemia on 4th postoperative day, for which conservative management was successfully carried out. A contrast-enhanced computed tomography(CT) was performed because a recurrence of nonocclusive mesenteric ischemia was suspected. It revealed a whirl sign in the small intestine, suggestive of small intestine volvulus. At the subsequent emergency laparotomy, volvulus caused severe congestion in the small intestine, aproximately 40 cm from the cecum. However, there was no evidence of transmural necrosis, and reduction of torsion notably improved blood supply to the small intestine. Her regular diet was resumed on 4th postoperative day, and her postoperative course was uneventful. Volvulus should be considered as a differential diagnosis in the setting of acute abdominal pain after open-heart surgery.

Publication types

  • Case Reports

MeSH terms

  • Abdominal Pain / diagnosis
  • Abdominal Pain / etiology
  • Aged
  • Coronary Artery Bypass / adverse effects
  • Female
  • Humans
  • Intestinal Volvulus* / diagnostic imaging
  • Intestinal Volvulus* / etiology
  • Intestine, Small / surgery
  • Mesenteric Ischemia* / diagnostic imaging
  • Mesenteric Ischemia* / etiology