A Case of Small Bowel Volvulus Caused by a Lipoma of Mesentery Which Showed a Distinctive Pattern on Preoperative Magnetic Resonance Imaging

Toru Ii, Toshiaki Yasui, Hiroshi Ito, Kazuhiro Mori, Toru Kamata, Ryuichi Akimoto, Masahiro Kanno

Department of Surgery and Gastroenterology, Keiju General Hospital

We report a rare case of small bowel volvulus caused by a lipoma of the mesentary. We also present a distinctive pattern on the coronal view of preoperative magnetic resonance imaging (MRI). A 60-yearold man was admitted to our hospital because of paraumbilical pain of persist severity. On physical examination the abdomen was soft and flat with mild paraumbilical tenderness. Laboratory data showed minimal leucocytosis. Abdominal computed tomography (CT) showed a fatty mass of 8 cm in diameter on the right flank. Some coronal views of abdominal MRI demonstrated whirling mesentery adjacent to the mass and a whirl-like pattern of the small bowel loops. Angiogram demonstrated a distorsion and high-grade stenosis of the superior mesenteric artery and a whirlpool arrangement of jejunal and ileal arteries. The patient was diagnosed as having small bowel volvulus caused by a lipoma of the mesentery, and underwent an emergency operation. At surgery, counterclockwise derotation was performed and the lipoma was removed by resection of both the mesentery and small bowel around the lipoma. He had an uneventful recovery and was discharged on the 31st postoperative day. Although the indication for MRI at abdominal emergency has been restricted in comparison with CT, we consider MRI to be useful in the diagnosis of small bowel volvulus.

Key words
lipoma of mesentery, small bowel volvulus, whirl-like pattern on abdominal magnetic resonance imaging

Reprint requests
Toru Ii Second Department of Surgery, Kanazawa University
13-1 Takara-machi, Kanazawa, 920 JAPAN

Accepted
June 14, 1995

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