Surgical Treatment of Primary Small Bowel Volvulus Using Laparoscopy

ABSTRACT

Small bowel volvulus is a condition that usually occurs secondary to malrotation, congenital bands, postoperative adhesions and internal hernias. However, primary small bowel volvulus in adults is very rare, and this is defined as torsion of all or a large segment of the small intestine and its mesentery in the absence of preexisting etiologic factors. This is relatively prevalent in the adult populations of Central Africa, India and the Middle East, but it rarely occurs in Western European and North American populations and in Far-East Asians, including Koreans. The preoperative diagnosis is difficult because clinical examinations and plain films are of limited diagnostic value. Abdominal CT plays a major role in the preoperative diagnosis of this entity. Proper management of patients with a strangulated obstruction depends on an early and accurate diagnosis, and treatment must be timely to prevent gangrene. Prompt preoperative management and early surgical treatment is essential for a better outcome. We report here on a case of a 49-year-old man who was admitted with severe abdominal pain, and he had no history of previous abdominal operations. He was diagnosed as primary small volvulus by diagnostic laparoscopy, and he was managed using this modality.