Orthodontic braces come back to bite: a novel presentation of a small bowel volvulus.

Shepherd T, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-221152 Description A previously well 30-year-old woman re-presented to the emergency department complaining of worsening central abdominal pain initially colicky at first presentation 2 days earlier. She was tachycardic at 105 and other vital signs were normal. Her abdomen was peritonitic. At initial presentation, she was thought to have biliary colic, even though ultrasound and hepatobiliary iminodiacetic acid scans were normal. She did not have plain abdominal films. Laboratory studies were normal. CT of the abdomen revealed a metallic wire-shaped foreign body at the mesenteric root of a small bowel volvulus (figure 1). The patient underwent an emergency laparotomy which discovered mid–small bowel ischaemia from a band adhesion related to the perforation of a 7 cm piece of orthodontic wire (figure 2). The wire penetrated through the small bowel and the small bowel mesentery and to another loop of the mid–small bowel. This had formed an axis around which the volvulus developed.