Abstract
We encountered a patient with primary volvulus of the small intestine, which is an uncommon disease in Japan. We successfully treated this patient without enterectomy. The patient, an 85-year-old woman, had no past history of laparotomy. She visited our hospital because of abdominal pain and vomiting. She was diagnosed as having had ileus by abdominal roentgenography, and was admitted to our hospital. Computed tomography of the abdomen revealed an image of the dilated intestinal tract and marked ascites, and emergency surgery was undertaken. The small intestine was found to show three clockwise rotations of the small intestine in the vicinity of the root of the superior mesenteric artery. No anatomical abnormalities capable of inducing the rotations were found, and primary volvulus of the small intestine was diagnosed. There was no necrosis of the small intestine, and the operation involved only retention of the axis rotations. Oral ingestion was initiated 3 days after the operation, and her course was favorable. This disease is rarely diagnosed preoperatively, but it is likely to rapidly lead to necrosis of the small intestine after its occurrence. To avoid loss of the opportunity for laparotomy in terms of timing, much attention should be given to patients with this disease, particularly elderly patients in poor general condition.
