case_images: PMC10851044_01
case_images: Preoperative small bowel series demonstrating megaduodenum. Dilated and elongated duodenum extending into the pelvis. The duodenum measures up to 11 cm along the third portion.
case_images: cureus-0016-00000051930-i01.jpg
case_images: PMC10851044_01_cureus-0016-00000051930-i01.jpg
case_images: FIG1
case_images: (A) Coronal and (B) sagittal views demonstrating megaduodenum. (C) and (D) Axial views demonstrating duodenal volvulus.. A) Coronal and B) sagittal computed tomography images demonstrating megaduodenum extending into the pelvis and closed-loop obstruction from the duodenal volvulus with pneumatosis intestinalis concerning for ischemia. C) Axial view of the duodenal volvulus with a significant mesenteric swirling with the pancreas (red arrow) being pulled into the volvulus. D) Axial view showing the volvulus with the distal stomach (blue arrow) and superior mesenteric artery (SMA) (yellow arrow) being pulled to the right of the midline by the volvulus. The blue star indicates a dilated duodenum with surrounding mesenteric swirling.
case_images: cureus-0016-00000051930-i02.jpg
case_images: PMC10851044_01_cureus-0016-00000051930-i02.jpg
case_images: FIG2
case_images: She was subsequently found on computed tomography (CT) to have a large duodenal volvulus with pneumatosis intestinalis of the massively dilated duodenum concerning for ischemia (Figure 2).
case_images: Intraoperative photos. A) Intraoperative photo showing the dilated duodenum being pulled out of the pelvis. B) Intraoperative photo demonstrating the megaduodenum after detorsion of volvulus (black arrow). The cecum (black star) has been displaced by the megaduodenum and is not fixed to the retroperitoneum. All bowel is healthy-appearing.
case_images: cureus-0016-00000051930-i03.jpg
case_images: PMC10851044_01_cureus-0016-00000051930-i03.jpg
case_images: FIG3
case_images: The duodenum was easily detorsed (Figure 3).
case_images: Postoperative upper gastrointestinal series demonstrating new duodenal anatomy with a reduced duodenal caliber after duodenal plication and duodenojejunostomy.. The red arrow points to the reduced duodenal caliber. The blue arrow points to the site of the duodenojejunal anastomosis. There was no leak noted.
case_images: cureus-0016-00000051930-i04.jpg
case_images: PMC10851044_01_cureus-0016-00000051930-i04.jpg
case_images: FIG4
case_images: A postoperative upper gastrointestinal contrast radiograph series obtained days later demonstrated her new gastrointestinal anatomy and confirmed the absence of any leak (Figure 4). 
case_images: Histopathologic analysis. A) Hematoxylin and eosin-stained tissue sections showing the segment of duodenum with villous attenuation and crypt hyperplasia (40x). Also shown are B) mild lamina propria expansion by chronic inflammation (100x), C) focal acute inflammation (100x), and D) focal ischemic changes (100x).
case_images: cureus-0016-00000051930-i05.jpg
case_images: PMC10851044_01_cureus-0016-00000051930-i05.jpg
case_images: FIG5
case_images: Microscopically, it showed mild lamina propria expansion by acute and chronic inflammation, focal ischemic changes, crypt hyperplasia, and villous attenuation (Figure 5).
case_images: Computed tomography and abdominal radiograph demonstrating pneumoperitoneum and dilated loops of bowel. A) Computed tomography axial image demonstrating multiple dilated loops of small bowel, intraperitoneal free air (blue arrow) near the left paracolic gutter concerning for perforated viscus, and pneumatosis intestinalis (red arrows) involving a small bowel loop.  B) Flat and upright abdominal radiograph demonstrating a large-volume pneumoperitoneum (blue arrow) and moderately dilated loops of the small bowel.
case_images: cureus-0016-00000051930-i06.jpg
case_images: PMC10851044_01_cureus-0016-00000051930-i06.jpg
case_images: FIG6
case_images: Her CT scan and abdominal radiograph were concerning for significant small bowel pneumatosis, dilated small bowel, and pneumoperitoneum of unknown etiology (Figure 6).