Internal Hernia with Small Bowel Volvulus in a Patient with Altered Gut Motility: A Complication of Direct Percutaneous Endoscopic Jejunostomy

Excerpt

A volvulus is a rare but important cause of small intestinal obstruction with a high incidence of eventual strangulation and bowel infarction [1]. The anatomic factors necessary for the development of a volvulus include a redundant segment of bowel that is freely movable within the peritoneal cavity and a bowel segment that is within close proximity to points of fixation. These prerequisite anatomic conditions are naturally present in the cecum and sigmoid colon, the most common sites of intestinal volvulus [1]. Direct percutaneous endoscopic jejunostomy (DPEJ), which involves endoscopically anchoring a loop of bowel to the abdominal wall allowing for direct access to the jejunum, places one at risk for volvulus due to the redundancy of the small bowel. …