Midgut Volvulus after Percutaneous Endoscopic Gastrostomy

Area of Science:

• Gastroenterology
• Surgical Procedures
• Abdominal Surgery

Background:

• Endoscopic gastrostomy tube placement is a common procedure for nutritional support.
• Intestinal obstruction is a potential complication following abdominal procedures.
• Small bowel volvulus (SBV) is a rare cause of intestinal obstruction characterized by twisting of the small intestine.

Observation:

• A 47-year-old male developed symptoms of intestinal obstruction two days after an uneventful endoscopic gastrostomy placement.
• Computed tomography revealed a well-positioned gastrostomy tube, pneumoperitoneum, and small bowel volvulus (SBV) with proximal small bowel dilation.
• Exploratory laparotomy confirmed mesenteric torsion causing SBV, with no evidence of intestinal malrotation.

Findings:

• Surgical untwisting of the volvulus successfully resolved the obstruction.
• The patient's presentation suggests a potential association between gastrostomy placement and the development of SBV.
• Mesenteric torsion was identified as the underlying cause of the SBV in this case.

Implications:

• This case underscores the need for heightened clinical suspicion for SBV in patients experiencing acute abdominal symptoms post-gastrostomy.
• Further investigation may be warranted to elucidate the potential pathomechanisms linking gastrostomy procedures to SBV.
• Early diagnosis and surgical intervention are crucial for managing SBV and preventing complications.