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We present the case of a 78-year-old female who presented to the emergency department with small bowel obstruction in a virgin abdomen. Although the patient did not have peritonism and biochemical investigations did not reveal alarming features of ischemia, an abdominal computed tomography (CT) scan was suggestive of small bowel volvulus (SBV), and operative exploration was pursued. No obvious cause was identified aside from hard stools throughout the colon and a diagnosis of primary SBV was determined. She was subsequently discharged symptom-free on day seven post-operatively. She represented on day 10 post-operatively with a similar history, examination, and abdominal CT findings suggestive of SBV recurrence. Her volvulus slowly resolved post administration of rectal enemas and did not require any further operative intervention; she was discharged on day eight of re-admission (day 19 post-operatively) with no recurrence of her symptoms on a regular diet. In this article, we discuss the management of SBV.

Background: Omental evisceration due to abdominal stab injuries connotes peritoneal penetration and translates to around 70% risk of intra-abdominal injury. Such cases are being managed with mandatory laparotomy at the Philippine General Hospital. This study aims to review the patient profile and laparotomy outcomes in such cases.Methods: This is a retrospective review of 98 consecutive laparotomies performed for patients with omental evisceration secondary to abdominal stab wounds between January 2004 to April 2018.Results: Almost all patients were male (99%) with a mean age of 32.1 years (range 14-70). The majority (81%) had a therapeutic laparotomy, and only 19 patients (19%) had a non-therapeutic laparotomy. The most commonly injured organs include the small bowel, stomach, colon, diaphragm, and liver. There was no significant difference in age, sex, duration of injury, systolic blood pressure and heart rate at presentation between the two groups. There were significantly more patients who presented with peritonism in the therapeutic laparotomy group compared to the non-therapeutic laparotomy group (82% vs 53%, p=0.005). Patients who presented with peritonism were six times more likely to have a therapeutic laparotomy. There was no significant difference between morbidity and mortality rates in the two groups. The length of hospital stay for the non-therapeutic laparotomy group was significantly shorter compared to the therapeutic laparotomy group (3.6 vs 5.7 days, p=0.006).Conclusion: The rate of therapeutic laparotomy remains to be significantly higher among patients with omental evisceration. Hence, omental evisceration, particularly those associated with peritonism, should continue to prompt operative management.