-Case Reports-

Primary Volvulus of the Small Intestine Exhibiting Chylous Ascites: A Case Report

Tamuro Hayama, Takeshi Shioya, Meishi Hankyo, Takao Shimizu, Hajime Shibuya, Osamu Komine, Yoshimasa Watanabe, Kotaro Nanbu and Taro Yamada

Department of Surgery, Saitama Citizens Medical Center, Saitama, Japan

Background: Primary volvulus of the small intestine associated with chylous ascites is very rare, with only four reported cases. In this paper, we report a new case of primary volvulus associated with chylous ascites.
Case Presentation: The patient was a 70-year-old man. After experiencing bloating and abdominal pain for several hours, he called an ambulance and underwent an emergency examination at our hospital. Abdominal distension, pressure pain, and rebound tenderness were observed throughout his entire abdomen. The patient had a history of hypertension for which he was receiving oral treatment. Abdominal contrast-enhanced computed tomography (CT) revealed an edematous change in the intestinal membrane and volvulus of the small intestine. As findings suggestive of ischemia were observed in part of the intestines, emergency surgery was performed on the day of admission. Open surgery revealed approximately 500 mL of chylous ascites in the abdominal cavity. The small intestine had twisted 180° in a counter-clockwise direction at the root of the superior mesenteric artery, and the mesentery appeared milky white with edematous changes extending 75 to 240 cm from the ligament of Treitz. There was no evidence of intestinal necrosis; therefore intestinal resection was not performed. The volvulus of the small intestine was corrected. Moreover, because there was no other underlying disease observed, surgery was completed. The ascites collected during surgery revealed high levels of triglycerides at 332 mg/dL, and chylous ascites was diagnosed. An abdominal CT performed on the third day after surgery showed an improvement in intestinal edema, and primary volvulus of the small intestine associated with chylous ascites was diagnosed. Postoperative progress was good, and the patient was discharged on hospital day 10.

J Nippon Med Sch 2017; 84: 83-86

Keywords
chylous ascites, volvulus, superior mesenteric artery, edema

Correspondence to
Tamuro Hayama, MD, Department of Surgery, Saitama Citizens Medical Center, 299-1 Shimane, Nishi-ku, Saitama city, Saitama 331-0054, Japan
nijinsky14@yahoo.co.jp

Received, April 15, 2016
Accepted, October 17, 2016