Volvulus of the Small Bowel in Adults

Abstract

The volvulus of the small bowel is a surgical emergency, causing small bowel obstruction. We performed a retrospective study of all the patients diagnosed and treated with small bowel volvulus between 1977 and 2007 at our institution. One hundred twenty-nine patients were analyzed. Thirty-nine patients presented primary volvulus and 90 secondary ones. The most frequent symptom was sudden abdominal pain. CT scan was the best diagnostic method with an accuracy of 83 per cent. Necrotic small bowel loops appeared in 46.5 per cent of the patients. Eighteen patients had postoperative complications (14%). Mortality rate was 9.3 per cent. A higher mortality is observed among patients with previous abdominal surgeries and cardiopathies. Necrotic loops are associated with higher mortality and incidence of surgical complications; patients with diabetes are associated with a higher incidence of necrotic loops. Cardiopathies are associated with more frequent medical and surgical complications. Recurrence rate was 3.9 per cent associated with simple devolvulation. Primary volvulus are more frequent among males and patients with diabetes. Jejunal location is associated with primary volvulus and these correlate with a higher incidence of necrotic loops. Primary volvulus presents a higher incidence of surgical complications. A bowel obstruction with sudden abdominal pain must be suspicious of small bowel volvulus. The main aim is to achieve an early diagnosis to prevent a necrotic small bowel. CT scan is the imaging test with the best diagnostic accuracy. Primary volvulus, the presence of necrotic loops, and patients with cardiopathies, diabetes mellitus, and with previous abdominal surgery are associated with a worse outcome.

Small bowel volvulus versus adhesive small bowel obstruction: a diagnostic dilemma in a 19-year-old woman

“…Secondary SBV, on the other hand, has been attributed to acquired conditions: most commonly post-operative adhesions, tumours, congenital anatomic anomalies and internal hernias 2 5 6. Rarely, it can come about as a complication of intestinal malrotation in adults.…”

“…Among the cases reported so far, some of them have reported that this devolution is often the only manoeuvre needed. However, given a reported 3.5% recurrence rate,6 some authors have advocated that some form of intestinal fixation or even resection of that redundant loop of small bowel be undertaken as well to avoid recurrence 2…”

Vólvulo primario de íleon: una rara forma de obstrucción intestinal en el adulto. Reporte de caso y revisión de la literatura

“…Otra es la teoría anatómica, la cual refiere que, en las poblaciones de alto riesgo, el mesenterio correspondiente al intestino delgado es más largo, con una inserción más estrecha y una falta de grasa mesentérica 10 . Por otro lado, el vólvulo secundario del intestino medio en el que hay una lesión preexistente aparece habitualmente en los pacientes de más edad (de sexta a octava décadas de vida) 14 . La causa más frecuente es la adhesión postoperatoria.…”

“…El vólvulo clínicamente asumido y radiológicamente demostrado requiere intervención quirúrgica inmediata debido al riesgo asociado de isquemia intestinal. La desvolvulación del intestino involucrado con frecuencia es la única maniobra que hay que realizar, aunque algunos autores recomiendan la fijación intestinal o incluso la resección para evitar la recurrencia del vólvulo 8,14,37 . A casi la mitad de los pacientes se les hará una resección de un intestino delgado gangrenoso 33 .…”

A Fatal Twist: Volvulus of the Small Intestine in a 46-Year-Old Woman

“…However, it accounts for 20–35% of small bowel obstructions in Asia, Africa, and the Middle East. A precipitating factor may be the ingestion of a large amount of fiber after extended periods of fasting during the Ramadan festival [ 1 – 3 ]. SBV may be primary, without any underlying anatomic abnormalities or known predisposing factors.…”