Abstract
Primary volvulus of the small intestine not caused by congenital malrotation or postoperative adhesions is a relatively rare entity, and in such cases as it is accompanied by a gangrenous small intestine, the prognosis is poor. We encountered a very elderly female patient with primary volvulus of the small intestine for whom massive resection of the small intestine was performed. Although she developed short bowel syndrome after the surgery, she had a good outcome.
A 90-year-old female admitted to another hospital for treatment of enteritis developed abdominal distention and vomiting, and was referred to our hospital with a diagnosis of small bowel obstruction. Abdominal CT scan showed a whirl-like sign suggestive of small bowel volvulus. Upon laparotomy, we found a gangrenous small intestine with mesenterium twisted clockwise by about 360°. After detorsion, the extensive gangrenous small intestine was resected. The residual small intestine was about 50 cm in length with the ileocecal junction which was kept intact. Since there were no apparent causes such as operative adhesion, anatomical abnormalities, and malformation, primary small intestine volvulus was diagnosed. Postoperatively, she had frequent bouts of watery diarrhea and was diagnosed with short bowel syndrome, but thereafter diarrhea got better. She was able to take orally without IVH on and after 48th postoperative day.
