Small bowel volvulus following laparoscopic cholecystectomy: A case report and literature review

Abstract

INTRODUCTION: Small bowel volvulus involves the twisting of an intestinal loop around the axis of its mesenteric attachment. Although rare, it is a potential complication of laparoscopic surgery, and every surgeon should be well aware of it. CASE PRESENTATION: We present a case of a 64-year-old patient admitted to our department with acute gastrointestinal obstruction six days after a laparoscopic cholecystectomy. CT showed dilated small intestine with a maximum diameter of 50 mm and a 2 cm subhepatic collection in the gallbladder bed. Emergency open surgery through a midline incision revealed necrosis of the twisted small intestinal loop, necessitating resection, and primary intestinal anastomosis. The postoperative course was uneventful and the patient was discharged on the eighth post-operative day. DISCUSSION: Small intestinal volvulus, even not a common complication following laparoscopic cholecystectomy, is nonetheless a serious condition that warrants careful clinical examination and imaging. The mechanism underlying this complication remains unclear; however, a review of similar cases in the English literature highlights several potential contributing factors. These include un-retrieved gallstones, anatomical abnormalities, and prior abdominal surgeries resulting in peritoneal adhesions and notably, in one case adhesions to a metallic clip. Interestingly, concerning our case, the volvulus appeared to result from a loop of bowel rotating around its mesenteric attachment with parietal adhesions acting as a pivot. In addition, we believe that the abscess, despite its 2 cm diameter, may have contributed to the postoperative ileus and thus facilitated the torsion of the small intestine creating a volvulus. CONCLUSION: Persistent postoperative abdominal pain and distention should not overshadow the possibility of acute intestinal obstruction after laparoscopy. Delayed diagnosis of bowel volvulus can lead to severe consequences, underscoring the importance of vigilance in postoperative assessments.