Small-intestinal volvulus around the superior mesenteric artery as an extremely rare positioning-associated complication after percutaneous liver biopsy.

Abstract

Small-bowel volvulus around the superior mesenteric artery is a very unusual cause of small-intestinal obstruction, which may result in intestinal ischemia and necrosis. A 45-year-old woman, who had received a living-donor liver transplant with a right lobe graft for fulminant hepatic failure 5 years earlier, underwent a liver biopsy and was placed in the right decubitus position. Abdominal pain, high fever, tachycardia, and altered mental status developed quickly, suggesting abdominal sepsis. Computed tomography (CT) showed a "target sign," representing a counter-clockwise rotation of the mesenteric pedicle. However, without laparotomy, the symptoms subsided completely within 12 h by her lying strictly in the left decubitus position. A second CT scan showed an orthotopic untwisted jejunum. Although many complications associated with percutaneous liver biopsy have been described, to our knowledge this is the first report of positioning-associated intestinal volvulus after a liver biopsy.

• Authors: Toru Ikegami, Yuji Soejima, Akinobu Taketomi, Noboru Harada, Hideo Uehara, Yo-Ichi Yamashita, Yoshihiko Maehara
• Journal: Surgery today (Surg Today) Vol. 38 Issue 6 Pg. 576-7 ( 2008) ISSN: 0941-1291 [Print] Japan
• PMID: 18516544 (Publication Type: Case Reports, Journal Article)

Topics

• Biopsy (adverse effects)
• Female
• Humans
• Intestinal Volvulus (diagnostic imaging, etiology)
• Jejunal Diseases (diagnostic imaging, etiology)
• Liver (pathology)
• Liver Transplantation
• Mesenteric Artery, Superior
• Middle Aged
• Posture
• Tomography, X-Ray Computed