PMC9924164_01
Abdominal radiograph: multiple gas-liquid planes in the intestinal gut.
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An abdominal radiograph revealed multiple air-fluid levels in the intestinal gut (Figure 1).
Abdominal ultrasonography: (A) A distended bowel can be seen below the umbilicus, and peristalsis is not apparent. The wall of the tube is thickened, and the lumen at the beginning of its expansion is compressed. (B) A dark area is seen between the intestines. (C) The intestinal wall is raised into the lumen, and the two intestinal tubes share the same wall of the bowel canal. (D) A small amount of colored blood flow signal can be seen on the wall of the dilated intestinal tube.
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Abdominal ultrasonography showed a dilated bowel sharing a common continuous wall with the distal segment (Figure 2).
Abdominal and pelvic computed tomography examination: A large cystic mass with a clear boundary can be seen.
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Computed tomography (CT) revealed thickening of the small intestinal wall and cystic intestinal dilation proximal to stenosis with clear margins (Figure 3).
Intraoperative findings (gross specimens): (A) The mass was generally ischemic, with darker color; the surface was covered with pus and no perforation was found; the proximal segment of the small intestine was dilated and hypertrophic, with inflammatory edema and punctate ischemia. (B) The basement wall was relatively weak, and the border of the normal bowel was clear. (C) Twisted sticky joints at the base of the mass compressed the adjacent normal intestinal canal.
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Several adhesive masses with punctate ischemia and inflammation, 20 cm proximally to the lesion, was also noted (Figure 4).
Pathological findings: (A) Small bowel cystic lesions: hemorrhage and necrosis were observed in the intestinal wall, and mesenteric vascular dilatation and congestion were observed, which was consistent with bleeding and necrotic alterations in the volvulus (hematoxylin and eosin staining, magnification x 100). (B) Intestinal ischemia and inflammatory tissue: examination of intestinal wall tissue showed presence of a mucosal layer of chronic inflammatory cell infiltration, with submucosal edema and thickening, while the smooth muscle layer was not abnormal (hematoxylin and eosin staining, magnification x 100).
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The pathological findings are shown in Figure 5.