P3267 - Twist and Turns of an Unusual Small Bowel Volvulus in a Patient With Gonococcal Arthritis

Natasha Mederos, MD¹, Luis A. Penaranda Bolano, MD¹, Mary Parianos, MD², Sarvani Ginjupalli, MD¹, Nemer Dabage-Forzoli, MD^1
1University of Miami Miller School of Medicine at Holy Cross Hospital, Fort Lauderdale, FL; ²Holy Cross Hospital, Fort Lauderdale, FL

Introduction: Volvulus of the small bowel is a rare, life-threatening condition characterized by the twisting of the intestine and its supporting mesentery, leading to bowel obstruction. Risk factors include malrotation, pregnancy, abdominal adhesions. In adults, the sigmoid colon and cecum are the most frequently affected, and it is more frequent in elderly males, African Americans, adults with chronic constipation, and associated neuropsychiatric disorders.

Case Description/Methods: A 47-year-old male with a past medical history of hypertension and treated syphilis presented to the emergency room with two days of right knee pain and swelling. He denied any other symptoms, as well as prior abdominal surgery or trauma. On arrival, the patient was found hypertensive and noted to have right knee swelling that was tender to palpation; the rest of the physical examination was unremarkable. Laboratory tests revealed hypokalemia of 3.1 mEq/L, elevated creatinine of 1.44 mg/dL, leukocytosis of 14.1, and high CRP at 167 mg/L. A knee X-ray revealed joint effusion and soft tissue calcifications. Subsequently, joint aspiration was performed, which yielded turbid fluid with a high white blood cell count and negative for crystals. Urine PCR for Neisseria gonorrhoeae was positive, confirming gonococcal arthritis. The patient was started on IV antibiotics and pain medication.

Two days later, the patient developed severe, non-radiating, epigastric abdominal pain with an intensity of 10/10. An emergent computed tomography (CT) scan of the abdomen and pelvis without contrast (Figure 1) revealed small bowel loops with wall thickening and severe edema. The center of the small bowel had a rotational “corkscrew” orientation with proximal bowel dilation and distal small bowel decompression. An emergent exploratory laparotomy was performed, revealing a portion of edematous and thickened small bowel with edematous mesentery proximally and a clear transition point to normal small bowel. During the procedure, a pedicle of the omentum involved in the volvulus was clamped, transected, tied, and sent for biopsy, which resulted in benign findings. The postoperative course was uncomplicated, and the patient was safely discharged home days later.

Discussion: Adult volvulus of the small bowel is an extremely rare condition. Our patient presented with what appeared to be an omental torsion, accounting for 1.1% of acute abdominal pain, believed, in our case, to be secondary to a high inflammatory state.



Disclosures:


Natasha Mederos, MD¹, Luis A. Penaranda Bolano, MD¹, Mary Parianos, MD², Sarvani Ginjupalli, MD¹, Nemer Dabage-Forzoli, MD¹. P3267 - Twist and Turns of an Unusual Small Bowel Volvulus in a Patient With Gonococcal Arthritis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.