Midgut Volvulus Caused by Mesenteric Lipoma

The patient presented to emergency ward with a 2-day history of moderate central abdominal pain, colicky in nature accompanied with nausea and vomiting. No mass was touched on palpation. Routine blood tests showed normal white cell count, urea, creatinine, amylase and electrolytes. Plain abdominal X-ray showed a gasless pelvis and lower abdomen, but laterally deviated and dilated intestinal loops. Abdominal ultrasonography revealed a loose ill-defined lobulated mass quite isoechoic with mesenteric fat in right lower abdomen displacing the echogenic small bowel loops gas. Computed tomography revealed a well-capsulated, homogeneous mass with negative HU about lipid density, 13×3×5 cm in size, filling the right portion of the inferior abdomen and pelvis, deviating the intestinal loops (Fig. 1). Volvulus of midgut by twisted (about 360° clockwise) appearance of the main mesenteric vessels in their root was depicted (Fig. 2). The diagnosis of volvulus was confirmed in color Doppler ultrasonography, where superior mesenteric vein was observed to lie in the left side of superior mesenteric artery. At laparotomy, after detorsion, a mesenteric lipoma was identified in the terminal ileum approximately 15 cm proximal to the ileocecal valve. Macroscopically a yellowish encapsulated, homogeneous mass measuring approximately 13×3×5 cm was revealed (Fig. 3).