A Surgical Case of Recurrent Small Bowel Volvulus in an Adult

Yuji Funayama, Iwao Sasaki, Eishi Miyashita*, Takayuki Mizoi, Takashi Doi, Seiki Matsuno

First Department of Surgery, Tohoku University School of Medicine
*Nagano Hospita

On May 12 in 1990, a 66-year-old farmer was admitted because of sudden onset of severe left lower abdominal pain while he was mowing grass. At the emergency operation after the diagnosis of acute abdomen, the ileum was found to be twisted 180° with clockwise rotation. Because there were no abnormal organic findings nor congenital anomaly, the diagnosis of primary small bowel volvulus was made. As the blood flow recovered quickly after the detorsion, intestinal resection was not performed. After an asymptomatic period, in the afternoon of January 1 in 1993, he complained of sudden onset of abdominal pain at his home. After conservative management he was referred to our clinic because symptom did not improve. On admission, he was alert and afebrile. The blood pressure was 160/90, and the heart rate was 66. Tachypnea or dyspnea was not seen. Physical examination revealed abdominal distension, intestinal contour, tenderness in the left lower quadrant and no bowel sound, but no muscle guarding. A plain roentgenogram showed fluid level and dilated loops of small intestine. An emergency operation was performed upon the diagnosis of recurrence of volvulus of the small intestine. Abdominal exploration revealed a gangrenous small bowel twisted by 360° counter-clockwise rotation around the mesenterium with no adhesion. The distal parts of the ileum adhered to each other, which suggested the site of the previous volvulus. Detorsion and intestinal resection of about 140 cm were performed. The postoperative course was uneventful, and he was discharged on the 43rd POD.

Key words
relapsing volvulus, primary volvulus of the small intestine in adult

Reprint requests
Yuji Funayama First Department of Surgery, Tohoku University School of Medicine
1-1 Seiryo-machi, Aoba-ku, Sendai, 980 JAPAN

Accepted
January 12, 1994

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