P4949 - A Case of Primary Small Bowel Volvulus in a Healthy 25-Year-Old Man

Yahya Alhalalmeh, MD¹, Murad Qirem, MD¹, Raed Atiyat, MD¹, Shirley Eng, ², Ahmed Gabr, ², Theodore DaCosta Jr, MD¹, Yatinder Bains, MD^1
1New York Medical College - Saint Michael's Medical Center, Newark, NJ; ²New York Medical College, New York, NY

Introduction: Volvulus occurs when an intestinal loop twists around its mesentery. It is more common in the sigmoid colon and cecum among the elderly, and in children, it often affects the small bowel and stomach. Small bowel volvuli are much less common than large bowel volvuli, and ileal volvuli are an even rarer subset. This case report details a unique instance of acute small bowel volvulus leading to necrosis and extensive ileal resection in a young patient without prior medical or surgical history.

Case Description/Methods: A previously healthy 25-year-old male presented to the Emergency Department with sudden-onset severe abdominal pain, vomiting, and diarrhea lasting 7 hours. He reported increased alcohol intake recently. On examination, he was tachycardic and had diffuse abdominal tenderness with guarding and rebound tenderness.




Laboratory findings showed elevated white blood cell count (29.50 x 10^9/L), neutrophils (25.8 x 10^9/L), and lactic acid (6.2 mmol/L). CT abdomen/pelvis revealed severe mechanical small bowel obstruction with ascites. Exploratory laparotomy revealed severe small bowel volvulus with two counterclockwise rotations, necessitating extensive ileal resection.




Histopathological examination of the resected specimen confirmed acute ischemic changes, with transmural congestion and extensive mucosal necrosis without perforation or tumors (Figure 1). Postoperatively, he recovered well and was discharged on day 3, with satisfactory outpatient follow-up on day 9.

Discussion: Small bowel volvulus (SBV) can be classified into primary and secondary, and is most commonly secondary to post-operative adhesions, congenital abnormalities, and tumors. SBV is rarely primary, with no pre-existing anatomical abnormalities as in our case. Primary SBV, lacking predisposing anatomical abnormalities, presents management challenges due to limited guidelines. Timely surgical intervention is crucial to prevent bowel necrosis, yet optimal strategies to prevent recurrence are debated. This case emphasizes the need for expanded research and definitive guidelines to manage primary SBV effectively, optimizing therapeutic approaches and preventing severe complications such as bowel necrosis and death.





Disclosures:


Yahya Alhalalmeh, MD¹, Murad Qirem, MD¹, Raed Atiyat, MD¹, Shirley Eng, ², Ahmed Gabr, ², Theodore DaCosta Jr, MD¹, Yatinder Bains, MD¹. P4949 - A Case of Primary Small Bowel Volvulus in a Healthy 25-Year-Old Man, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.