Primary volvulus of the small intestine

Abstract

Small bowel volvulus is an occasional cause of mechanical intestinal obstruction in our practice causing diagnostic problems. We report a case of primary small bowel volvulus with gangrene. A 30-year-old farmer who presented with features of acute intestinal obstruction, which at laparotomy revealed a primary small bowel volvulus with a gangrenous loop of ileum. The patient was resuscitated and had exploratory laparotomy; with operative findings of a twisted loop of gangrenous ileum adjoining the ileocecal valve. This was resected and an end to end ileotransverse anastomosis effected. The patient made an uneventful recovery and was discharged on the 7 th postoperative day. Primary small bowel volvulus should be suspected in acute intestinal obstruction. It presents as an acute abdomen due to occlusion of bowel lumen alone or with obstruction of its blood supply leading to gangrene. Treatment includes resection and end to end anastomosis, which can help to reduce mortality and morbidity.