title: A Fatal Twist: Volvulus of the Small Intestine in a 46-Year-Old Woman.
abstract: A 46-year-old woman presented to two emergency departments within 12 hours because of acute abdominal pain. Physical exam demonstrated tenderness and epigastric guarding. An ultrasound was interpreted as negative; she was discharged home. Later that evening, she was found dead. Postmortem exam revealed acute hemorrhagic necrosis of a segment of jejunum secondary to volvulus. Clinical clues suggesting presentations of small bowel volvulus are usually nonspecific; the diagnosis is typically confirmed at surgery. Her unremitting abdominal pain, persistent vomiting, and absolute neutrophilia were consistent with an acute process. The etiology of this volvulus was caused by an elastic fibrous band at the root of the jejunal mesentery. While congenital fibrous bands are rare in adults, this interpretation is favored for two reasons. First, the band was located 20 cm superior to postsurgical adhesions in the lower abdomen and pelvis. Second, there was no history of trauma or previous surgery involving the site of volvulus.
authors.affiliation: Department of Pediatrics, Virginia Commonwealth University Health System, Richmond, VA 23220, USA.
authors.forename: Jared
authors.initials: J
authors.lastname: Klein
authors.affiliation: Department of Internal Medicine, University of Minnesota Medical Center, Minneapolis, MN 55454, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Baxstrom
authors.affiliation: Departments of Family Medicine and Emergency Medicine, Christiana Care, Wilmington, DE 19899, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Donnelly
authors.affiliation: Department of Pathology, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Feasel
authors.affiliation: Department of Pathology, Wright State University, Dayton, OH 45435, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Koles