Primary Small Bowel Volvulus: An Unusual Cause of Small Bowel Obstruction

Abstract

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.

Small Bowel Volvulus In Adult: A Review Of Literature

“…The annual incidence of SBV is 3.5 cases [14]. The SBV accounts for 1 to 25 % of small bowel obstruction (SBO) [1], [5], [7], [11], [15] and 1.7 to 27% of all intestinal obstruction (IO) [4], [13] - [17].…”

“…Obstruction and strangulation frequently crop up and progress quickly to gangrene as the mesenteric twist tends to be very tight leading to early vascular involvement [20]. The sequelae of that will steer to intestinal obstruction, bowel gangrene, perforation peritonitis [1], [7]. If an extensive segment of the loop is involved, then a large volume of blood and plasma are extravasated into the intestinal wall and lumen.…”

“…Santin-Rivero et al stated that leucocytosis is present in 66% of the patients with mesenteric torsion but leucocytes count of over 10,000/cm3 was invariably present in 100% of the patients who developed bowel necrosis [37]. C. L. N. Tsang et al reported that among biochemical markers, an elevated lactate level can indicate mesenteric ischemia or necrosis but this too can be normal in the presence of necrosis [1].…”

“…Once SBV is suspected there is no room to consider for conservative treatment and immediate Laparotomy is indicated as volvulus with compromised vascular status carries a greater risk of gangrene The management of SBV consists of conservative and/or surgical measures. Though the main treatment of SBV is surgical exploration, other supportive measures are Intravenous fluid supplement, insertion of Ryle's Tube and self-retaining catheter, and venous thromboembolism prophylaxis [1].…”

“…A Small bowel volvulus (SBV) is a rare condition [1] where the small bowel (SB) twists around its own mesenteric axis [2]. The incidence of SBV varies between 0.00001% to 0.19% [3].…”