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Case Reports in Medicine
Volume 2015, Article ID 391093, 4 pages
http://dx.doi.org/10.1155/2015/391093
Case Report

A Fatal Twist: Volvulus of the Small Intestine in a 46-Year-Old Woman

1Department of Pediatrics, Virginia Commonwealth University Health System, Richmond, VA 23220, USA
2Department of Internal Medicine, University of Minnesota Medical Center, Minneapolis, MN 55454, USA
3Departments of Family Medicine and Emergency Medicine, Christiana Care, Wilmington, DE 19899, USA
4Department of Pathology, Cleveland Clinic, Cleveland, OH 44195, USA
5Department of Pathology, Wright State University, Dayton, OH 45435, USA

Received 21 July 2015; Revised 12 October 2015; Accepted 15 October 2015

Academic Editor: Gerald S. Supinski

Copyright © 2015 Jared Klein et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.