Image of the Month—Diagnosis | Congenital Defects | JAMA Surgery | JAMA Network
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Special Feature
May 2011May 16, 2011

Image of the Month—Diagnosis

Arch Surg. 2011;146(5):630. doi:10.1001/archsurg.2011.107-b

The presence of a volvulus was apparent on laparotomy. Tuberculosis may involve the mesentery but has not been described with volvulus. Mesenteric lymphangiomatosis (which is a congenital malformation of the lymphatic channels) and mesenteric lipoma (which is a benign neoplasm) both may act as a lead point for volvulus but would not account for the whitish discoloration seen nor the whitish fluid in the abdomen. Laparotomy revealed a midgut volvulus with the bowel torsed twice around its mesenteric blood supply. Detorsion of the bowel led to resolution of the whitish coloration of the mesentery, confirming that the color was related solely to a mechanical lymphatic obstruction.