A Case of Primary Volvulus of the Small Intestine Diagnosed Early by Characteristic CT Findings

Daisuke Kobayashi, Ichiro Honda and Masahiro Mori

Department of Surgery, Shinshiro Municipal Hospital

We report a rare case of volvulus of the small intestine. A 82-year-old man seen for abdominal pain, constipation, and vomiting had severe tenderness and a mass of the upper abdomen and no history of laparotomy. Abdominal computed tomography (CT) showed a whirl mass involving the small bowel and mesentrium around the superior mesenteric artery. The patient was diagnosed as having volvulus of the small intestine and underwent emergency surgery 1 hour after hospitalization. The small intestine was found to be twisted clockwise by 540 degrees at the root of the superior mesenteric artery. Because of the absence of adhesion, tumors, and predisposing anatomical abnormalities, we diagnosed primary volvulus of the small intestine. The small intestine had not necrosed, so surgey involoved only returning axis rotaions. His course was favorable and he was discharged 14 days after surgery. Volvulus of the small intestine must be considered as a probable diagnosis when a patient shows strangulated ileus without any history of laparotomy. Abdominal CT scan provides useful information for diagnosing this disease.

Key words
primary volvulus of the small intestine, whirl sign, abdominal CT

Reprint requests
Daisuke Kobayashi Department of Surgery, Tosei General Hospital
160 Nishioiwake, Seto, 489-8642 JAPAN

Accepted
May 31, 2006

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