Unusual case of chronic small bowel volvulus with narrowing but no obstruction. The patient presented with lower extremity swelling and tachycardia, presumably a result of chronic venous congestion, and surprisingly because the dilated duodenum compresses the IVC (annotated image). 

Chronic volvulus can be concluded by the lack of obstruction, compensatory enlargement of the duodenum, and because a large meandering varix bypasses the narrowing/twisting of the SMV.