Giant Jejunal Diverticulosis Causing Acute Mesenteric Volvulus: a Case Report

Large jejunal diverticula are usually asymptomatic but can cause rare, life-threatening complications including obstruction, perforation, and bleeding. Secondary mesenteric volvulus caused by jejunal diverticulosis is exceptionally rare. It should be strongly considered when computed tomography (CT) reveals a mesenteric "whirl sign" in an adult presenting with acute obstructive symptoms.

A 76-year-old female presented to the emergency department with acute, diffuse abdominal pain and clinical evidence of mechanical intestinal obstruction. A CT scan demonstrated the characteristic whirl sign of a mesenteric volvulus. Due to severe bowel distension, an urgent open laparotomy was performed. Intraoperatively, a 180-degree torsion of a 60-cm jejunal segment, located 30 cm distal to the ligament of Treitz, was identified. Five giant, fluid-filled diverticula along the mesenteric border created an asymmetric weight burden and localized dysmotility, acting as a mechanical fulcrum that precipitated the volvulus. Thorough exploration explicitly excluded adhesions, bands, internal hernias, or malrotation. No gross mesenteric ischemia was observed. Primary manual detorsion restored complete bowel viability, safely avoiding resection. The postoperative course was unremarkable and the patient remained asymptomatic at the six-month follow-up.

Giant jejunal diverticulosis can act as a physical fulcrum causing secondary mesenteric volvulus. Early open surgical exploration and primary detorsion can achieve complete bowel salvage, preventing the significant morbidity associated with intestinal resection in elderly patients.