A Case of Primary Volvulus of the Small Intestine in Adults

Shun Kudo, Jin-ichi Kameyama, Akira Suzuki, Yousuke Sakai, Shigeo Hasegawa, Kumiko Suzuki

Department of Surgery, Yamagata Prefectural Nihonkai Hospital

A 71-year-old woman admitted with complaints of abdominal pain and vomiting. Abdominal findings were not remarkable except for mild tenderness. But two days later, there was severe tenderness in the abdomen with peritoneal sign. Abdominal CT demonstrated a whirl-like pattern of volvulated small intestinal loops around the superior mesenteric artery. An emergency operation was performed upon the diagnosis of strangulated ileus due to volvulus of the small intestine. Abdominal exploration revealed a gangrenous small intestine from about 30 cm from Treitz ligament to near the terminal ileum twisted by 900° clockwise rotation. After detorsion, the extensive gangrenous small bowel was resected and end to end anastomosis was performed. The postoperative course was uneventful Because of the absence of a predisposing anatomical abnormality, the patient was diagnosed as having primary volvulus of the small intestine. Reports of primary volvulus of the small intestine are very few in Japan, and care should be taken for this disease because it develops necrosis rapidly, resulting in high mortality. Abdominal CT may provide useful information and may be essential to an early diagnosis of this disease.

Key words
primary volvulus of the small intestine, whirl-like pattern, abdominal CT

Reprint requests
Shun Kudo Department of Surgery, Yamagata Prefectural Nihonkai Hospital
30 Akiho-cho, Sakata-city, 998-8501 JAPAN

Accepted
May 19, 1998

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