Small-intestinal volvulus around the superior mesenteric artery as an extremely rare positioning-associated complication after percutaneous liver biopsy.
Small-bowel volvulus around the superior mesenteric artery is a very unusual cause of small-intestinal obstruction, which may result in intestinal ischemia and necrosis. A 45-year-old woman, who had received a living-donor liver transplant with a right lobe graft for fulminant hepatic failure 5 years earlier, underwent a liver biopsy and was placed in the right decubitus position. Abdominal pain, high fever, tachycardia, and altered mental status developed quickly, suggesting abdominal sepsis. Computed tomography (CT) showed a "target sign," representing a counter-clockwise rotation of the mesenteric pedicle. However, without laparotomy, the symptoms subsided completely within 12 h by her lying strictly in the left decubitus position. A second CT scan showed an orthotopic untwisted jejunum. Although many complications associated with percutaneous liver biopsy have been described, to our knowledge this is the first report of positioning-associated intestinal volvulus after a liver biopsy.
Ikegami
Toru
T
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Soejima
Yuji
Y
Taketomi
Akinobu
A
Harada
Noboru
N
Uehara
Hideo
H
Yamashita
Yo-Ichi
Y
Maehara
Yoshihiko
Y
D001706:Biopsy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D045822:Intestinal Volvulus / Q000000981:diagnostic imaging / Q000209:etiology*; D007579:Jejunal Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D008099:Liver / Q000473:pathology*; D016031:Liver Transplantation; D017538:Mesenteric Artery, Superior; D008875:Middle Aged; D011187:Posture; D014057:Tomography, X-Ray Computed