Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

GASTROINTESTINAL
Year
: 2006  |  Volume : 16  |  Issue : 4  |  Page : 513--514

Multiple jejunal lipomatosis - a rare cause of midgut volvulus


R Bavaharan, N Karunakaran, T Mukuntharajan, NS Mani 
 Department of Imaging Sciences, Meenakshi Mission Hospital & Research Centre, Lake Area, Madurai, Tamil Nadu, India

Correspondence Address:
R Bavaharan
Department of Imaging Sciences, Meenakshi Mission Hospital & Research Centre, Lake Area, Madurai, Tamil Nadu
India




How to cite this article:
Bavaharan R, Karunakaran N, Mukuntharajan T, Mani N S. Multiple jejunal lipomatosis - a rare cause of midgut volvulus.Indian J Radiol Imaging 2006;16:513-514


How to cite this URL:
Bavaharan R, Karunakaran N, Mukuntharajan T, Mani N S. Multiple jejunal lipomatosis - a rare cause of midgut volvulus. Indian J Radiol Imaging [serial online] 2006 [cited 2020 Jan 25 ];16:513-514
Available from: http://www.ijri.org/text.asp?2006/16/4/513/32259


Full Text

A 61 year old male was admitted with history of severe colicky abdominal pain and Vomiting.

Blood investigations were within normal limits.

Plain Radiograph of the abdomen showed dilated air filled bowel loops Contrast enhanced CT showed twisting of SMA, SMV & adjacent mesentry .Multiple Fatty attenuation lesions seen in the submucosal portion of jejunal loops.

The diagnosis of Midgut Volvulus with Multiple Jejunal Lipomatosis was made Patient was taken up for emergency exploratory laprotomy under GA.Resection of 60 cm jejunam having submucosal lipomas with gangrenous changes & end to end anostomosis done .

Biopsy was suggestive of multiple submucosal jejunal lipomatosis.

Postoperaive period was uneventful .Sutures removed on day7 & patient discharged.

Discussion :

Midgut volvulus

Midgut volvulus is torsion of entire gut around Superior Mesentric Artery.Usually affects neonates/young adults, rarely adults.20% are associated with duodenal atresia, duodenal diaphragm, duodenal stenosis, & annular pancreas. In our case it was associated with multiple jejunal lipomatosis.

The degree of twisting can change due to natural movement of the bowel that determines the symptamatology.

Radiological features:

Plain Abdominal Xray shows dilated air filled bowel loops and double-bubble sign. In closed loop obstruction there is closed loop collection of air

Barium study shows dodenojejunal junction located below duodenal bulb & highly placed caecum, apple-peel or corkscrew appearance due to spiral course of midgut

loops, thumb printing appearance and deodenal fold thickening

USG shows clockwise whirlpool sign, SMV to left of SMA, Thick walled bowel loops below the dilated duodenum

CT shows Whirl-pool pattern of small bowel loops

CT Angiogram shows Spiraling of SMA called Barber Pole

sign. Abrupt termination of vessels ,prolonged contrast transit time,absent venous opacification. Complications include Intestinal ischemia & necrosis

Lipoma

Lipoma is the most common submucosal beningn tumor of GIT, colon> duodenum> ileum> stomach> jejunum> esophagus

Lipoma with short thick pedicle is prone to intussuscept. It can also occur as multiple lesions. In barium studies it is radiolucent filling defect with narrowing of the lumen. It changes in size & shape on compression.

CT study shows a sharply defined intramural mass of fat density

Complications include intussesception, rarely ulceration & in our case volvulus[6]

References

1CMAJ.2004 Sep 28;171(7): 728 Volvulus:Arare Twist on Small Bowel Obstruction ; katis PG et al
2J.Radiol.2004 Feb;85(2pt1):18-30 Jejunal Lipomatosis with intessuseption and volvulus .A Case report ; Bissen et al
3Radiology.2000 Sep ; 216(3):727-30 Jejunal Lipomatosis secondary to lipoma ; Ross et al
4Abdom Imaging .1996 Nov-Dec; 21(6):522-4.Lipoma -Induced jejunal intessuseption ; Urbano J et al
5Acta RAdiol.2000Mar;43(2):196-7 Jejunal Intussuseption secondary to Lipoma ; Cakira S et al
6J.Radiol : Jul-Aug; 83(7-8): 986-8. Jejunal Volvulus secondary to torsion of pedunculated subserosal lipoma: CT disgnosis of a rare cause of bowel obstruction ; Bartrier et al