A CASE OF SMALL INTESTINAL VOLVULUS IN AN ADULT

Abstract

In patients without previous history of undergoing abdominal surgery, primary volvulus with necrosis of the small intestine is rarely encountered disorder. Recently, we experienced such a case. A 31-year-old woman, teacher of the piano, was admitted to the hospital because of sudden onset of abdominal pain after having a midnight snack. There was tenderness in the entire abdomen. WBC was 9, 200/mm³ and CRP was 0.3mg/dl. Plain X-ray film of the abdomen revealed small intestinal gas and CT scan revealed a small amount of ascites and the thickness of the small intestinal wall. Symptomatic remission was attained by administration of analgesics. On the next day, she was operated on because a mass 10cm in diameter was felt at the right abdomen. At laparotomy, a bloody ascites was present and the gangrenous small bowel was found to be twisted by 540° with clockwise rotation around the mesenterium. A resection of the necrotic bowel and an end-to-end anastomosis were performed. Volvulus of the small intestine must be considered as a probable diagnosis when the patient presents with acute abdomen without any histories of undergoing laparotomy.