Small Bowel Volvulus With Chylous Ascites Following Total Gastrectomy

Torsion of the small bowel around its mesenteric axis can lead to small bowel volvulus (SBV) and subsequent small bowel necrosis. Chylous ascites (CA) is attributed to lymphatic damage and compression/obstruction of lymphatic vessels. There are few case reports of SBV with CA. A 70-year-old man, who had a history of laparoscopic total gastrectomy 10 years ago, presented to our emergency department with acute abdominal pain that lasted for 1 hour after eating dinner. The patient was diagnosed with acute small bowel obstruction secondary to SBV based on curved planar reconstruction (CPR) and underwent emergency surgery. The abdominal cavity had CA, the small bowel and mesentery showed overall white edematous changes, and the small bowel mesentery was twisted 360 degrees, but there was no small bowel ischemia or necrosis. After detorsion, surgery was completed. The postoperative course was uneventful, and the patient was discharged on postoperative day 9. CPR is useful for diagnosing SBV in cases without typical CT findings. SBV with CA may not require small bowel resection due to necrosis, because occluded lymphatic vessels lead to small bowel and mesenteric edema, which inhibits further twisting. Additionally, surgical intervention is performed because of acute abdominal pain. We assume that dietary guidance is important because dietary factors may also be involved in SBV.