Primary Midgut Volvulus: An Unusual Case of a Young Adult Necessitating Extensive Bowel Resection.

Primary small bowel volvulus (SBV), commonly known as midgut volvulus, is an uncommon condition in which the small intestine rotates around its own mesenteric axis. This case report details the diagnostic and management challenges encountered in a rare presentation of primary SBV in a previously healthy 19-year-old male. Our patient presented with acute abdominal pain, vomiting, and signs of shock, prompting urgent medical attention. He was sent for exploratory laparotomy and underwent extensive resection of the gangrenous bowel. Diagnosis involved an abdominal computed tomography scan revealing the characteristic "whirl sign." According to the World Society of Emergency Medicine, surgical intervention should be done to address the SBV through resection of the gangrenous bowel segments. Despite efforts, the patient's prognosis remained guarded, necessitating ongoing supportive measures. This case highlights the complex challenges associated with primary SBV, emphasizing the need for continued research to enhance diagnostic precision and refine management strategies.

Petersen's Hernia After Roux-en-Y Gastric Bypass: A Case Report.

Internal hernia (IH) is the protrusion of abdominal contents, mostly small bowel loops, through a defect in the peritoneum or mesentery. Petersen's hernia is a type of internal hernia, in which part of the intestinal loop protrudes through a defect between small bowel limbs, transverse mesocolon, and retroperitoneum. It has been reported in individuals undergoing gastrojejunostomy (GJ), especially following bariatric surgeries. Because of the expanding popularity of these surgical treatments, the total incidence of internal hernias has recently increased. The laparoscopic Roux-en-Y gastric bypass (RYGB) has been proven to be a safe and successful alternative to the classic open RYGB. Although the absence of postoperative adhesions is one advantage of minimally invasive surgery, it facilitates the occurrence of internal hernia with reported rates of 5% three months to three years following surgery. Clinical findings are vague and can vary from mild to severe abdominal pain that can be accompanied by vomiting, nausea, and abdominal distention.

Sclerosing Encapsulating Peritonitis Mimicking an Internal Hernia: A Case Report.

Sclerosing encapsulating peritonitis (SEP) is a rare entity that could lead to abdominal obstruction; however, despite being reported in several case series, its underlying pathophysiology is still unclear. A large proportion of SEP cases are diagnosed incidentally or after surgical exploration, which poses a great challenge to pre-operative diagnosis. We hereby report a case of a 33-year-old male patient who presented with cachexia and a clinical picture of complete small bowel obstruction. CT scan of the abdomen raised suspicion of an internal hernia, prompting explorative surgical evaluation. Laparoscopy showed encasement of the small bowel loops in a thick fibrocollagenous membrane characteristic of SEP. Laparotomy with adhesiolysis and membrane excision successfully led to the resolution of obstruction. Retrospective interpretation of the initial CT scan confirmed the presence of SEP's characteristic radiological signs and provided an insight into how it contrasts with an internal hernia. This case provides an opportunity to highlight the differences between the two clinical entities and the pre-operative diagnostic strategies.