Abstract
An 80-year-old woman under treatment for systemic sclerosis visited our hospital for abdominal distension and vomiting. The patient was given a diagnosis of small bowel volvulus based on the presence of a "whirl sign" on abdominal CT and underwent an emergency operation. The small bowel was twisted 540 degrees clockwise around the superior mesenteric vessels but was not necrotized. A simple detorsion was carried out. However, on postoperative day 39, the patient complained of abdominal pain. Abdominal CT demonstrated the "whirl sign" again, and an emergency operation was carried out under the diagnosis of recurrent small bowel volvulus. The small bowel was twisted 180 degrees counterclockwise around the superior mesenteric vessels. After detorsion, we added a mesenteric plication according to the Childs-Phillips procedure. While advantages of mesenteric fixation for small bowel volvulus are still uncertain, it can be said that mesenteric fixation must be considered in recurrent cases. Because the association between systemic sclerosis and small bowel volvulus is unclear, this case is intriguing.
