A case of primary volvulus of the small intestine in an elderly patient

Abstract

An 85-year-old woman who had felt intermittent periumbilical pain since July 2007 and experienced body weight loss of 10kg during 6 months was seen at our emergency clinic because of severe periumbilical pain and vomiting in May 2008. There were strongest tenderness in the periumbilical area and left upper quadrant of abdomen. She was diagnosed as having intestinal obstruction by an abdominal X-ray film. Furthermore, an abdominal CT scan showed whirl sign. We diagnosed the case as volvulus of the small intestine and performed emergency operation to reduce axis rotations. At laparotomy, the small intestine was twisted counterclockwise by 360 degree around the superior mesenteric artery. We considered it primary volvulus, as there was no organic lesion and anatomical disorder causing volvulus of the small intestine. Some elderly people may show few clinical symptoms and minimal changes in laboratory data even if they have volvulus of the small intestine, and they may experience acute aggravation after following the chronic clinical course, like in this case. Accordingly the possibility must be kept in mind in making diagnosis.