Primary ileal volvulus: a rare twist in an elderly patient—case report

Abstract

Background Small bowel volvulus is a rare entity and it is even rarer for the ileum to undergo torsion without any known predisposing factors. It presents as acute abdomen with features of intestinal obstruction. As it is a life-threatening condition, it should be kept as a differential for small bowel obstruction despite its rarity. Therefore, we report this case. Case report A 60-year-old gentleman presented to our emergency department with a 2-day history of worsening abdominal pain, vomiting, abdominal distension and obstipation. Exploratory laparotomy was done which revealed ileal volvulus with no predisposing factors. Derotation of the segment was done. The postoperative period was uneventful and on follow up after a month, he had a satisfying recovery. Conclusion Though primary ileal volvulus is a rare diagnosis, it should be kept in mind in any patient with small bowel obstruction with pain out of proportion and resistant to opioid management. Early diagnosis and urgent surgical intervention is the key to prevent bowel necrosis and associated morbidity and mortality.

Jejunal volvulus within an inguinal hernia sac like as an extremely rare cause of acute mechanical gastrointestinal obstruction in adults: First literature report

“…Secondary SBV is mainly due to postoperative adhesions, fibrous band, Meckel's diverticulum, congenital malrotation of the gut, tumours, mesenteric lymph nodes, parasitic infestations, internal hernias, lipomas, pregnancy, endometriosis, hematomas, aneurysms, tuberculosis, intestinal duplication, jejunal diverticulum, small bowel diverticula, paraduodenal hernia. [6] , [8] , [9] . This is the first case of a JV secondary to a inguinal hernia reported in the literature: we suppose that the presence of jejunal loops within the inguinal hernia sac have induced forceful bowel peristalsis resulting in JV.…”

“…Color Doppler US can demonstrate the encircling of the small bowel loops and the superior mesenteric vein around the superior mesenteric artery, which is termed the “whirlpool sign”, with a sensitivity, specificity and positive predictive value of 92%, 100% and 100% respectively [15] . Abdominal CECT represents the investigation of choice with a sensitivity of 60%–100% and a specificity of 90%–95% [16] : it can demonstrate “whirl sign”, “spoke wheel sign”, “beak sign”, “barber pole signs”, signs of small bowel obstruction (dilatation of closed or air-filled bowel loops) and ischemia (thickening or presence of air in the bowel wall, portal vein gas, free peritoneal fluid); however none of these findings is pathognomonic of SBV [8] . M. Lepage-Saucier et al observed on abdominal CECT three signs of SBV which are multiple transition points, transition points located ≤7 cm from the spine in the anteroposterior plane and the whirl sign: the presence of any one of these signs confirms SBV with a sensitivity of 94%, the presence of all signs confirms SBV with100% specificity [1] .…”

Primary Segmental Small Bowel Volvulus in an Adolescent Female

“…16 While mortality is raised significantly in the presence of gangrenous bowel, there is potential for patients to recover uneventfully after detorsion of SBV without bowel resection. [2][3][4]9,19,20 In patients who appear clinically well after the first exploration, it seems reasonable to take a relaparotomy on-demand approach. In our case, a markedly ischemicappearing bowel segment fully recovered while sparing the patient the additional risks and complications of bowel resection or a second surgery.…”

Recurrent midgut volvulus in an 83-year-old female

“…Midgut volvulus in adults is rare, with only about 120 case reports and an additional 200 patients in case series reported in the literature as of 2020 [ 1 ]. Previous case reports have reported recurrent midgut volvulus in patients with a history of childhood Ladd’s procedure [ 1 ], or an isolated incident of volvulus in elderly patients with no predisposing factors [ 2 ]. Cases in the elderly were managed with simple untwisting of the mesentery [ 2 , 3 ].…”

“…Previous case reports have reported recurrent midgut volvulus in patients with a history of childhood Ladd’s procedure [ 1 ], or an isolated incident of volvulus in elderly patients with no predisposing factors [ 2 ]. Cases in the elderly were managed with simple untwisting of the mesentery [ 2 , 3 ]. Overall, it is exceedingly rare to encounter primary midgut volvulus in adult patients with neither evidence of intestinal malrotation nor mechanical causes of volvulus, such as jejunal diverticula [ 4 ].…”