Abstract
A 57-year-old man with no past history of laparotomy was admitted for sudden onset of severe upper abdominal pain. Plain X-ray of the abdomen showed a little gas in the small intestine. Abdominal contrast-enhanced computed tomography demonstrated a so-called “whirl-like pattern” by which the small bowel loops around the superior mesenteric artery. We suspected volvulus of the small bowel, and undertook an emergency operation. It was found that the small intestine, from 210 cm anal to the Treiz ligament, rotated 180° clockwise under mesenteroaxic torsion. Because there were neither anatomical abnormalities, nor adhesions, we diagnosed primary volvulus of the small intestine. The strangulated intestine was removed and a jejunojejunostomy was perfomed. The patient was discharged on day 9 after the operation. Primary volvulus of the small intestine is reportedly rare in Japan, and difficult to diagnose preoperatively. But early diagnosis and treatment were possible in this case, because we could identify the charactevistic whirl-like pattern.
