Primary Small Bowel Volvulus in a Child

Abstract

A case of primary small bowel volvulus presenting with diffuse peritonitis is reported. A 10-year-old female was admitted to our hospital complaining of abdominal pain. On admission muscular guarding and the Blumberg sign were noted in the abdomen. An abdominal X-ray film showed a small bowel gas shadow without a level. Abdominal CT was performed and showed multiple distended small bowel loops with their edematous mesenteric folds converging toward the point of torsion and thickening of the bowel wall. These findings suggested volvulus of the small intestine, and emergency surgery was performed. On laparotomy, massive small bowel necrosis was observed and the root of the mesentery of the small intestine was twisted clockwise approximately 360°. Resection of the necrotic small intestine was performed and the length of the surviving intestine was 2.5m. We made a diagnosis of primary small bowel volvulus because no bands or adhesions were observed in the abdominal cavity. The patient's postoperative course was uneventful, and the patient was discharged on the 22nd day. Primary small bowel volvulus is rare, and diagnosis is very difficult. This case report suggests that CT findings are useful in the diagnosis of primary small bowel volvulus.