Volvulus of the small intestine in adults

Abstract

The presentation and subsequent management of 53 patients with volvulus of the small bowel are reviewed. Important features of the presentation are the acute onset of the abdominal pain and its severity which is often inconsistent with the findings on clinical examination. The diagnosis was made preoperatively from plain abdominal x-rays in only 1 patient, although several radiological features are described. In 16 patients there were no obvious predisposing factors, although in the remaining 37 patients the volvulus occurred as a consequence of a predisposing anatomical abnormality. The mortality rate associated with volvulus in the presence of gangrenous small bowel is 47%. In the management of a patient presenting with small bowel obstruction, the possibility of volvulus must be considered in order to reduce this high mortality.Small bowel volvulus is a condition in which there is a torsion of all or a segment of the small bowel and its mesentery. It is a well-recognized entity in neonates as a consequence of anomalies of midgut rotation [1]. Although the condition is one of the more common surgical emergencies in the adult population of Central Africa, Asia, and Middle Eastern nations [2], small bowel volvulus occurs only rarely among Europeans and North Americans. The purpose of this study is to review the experience in 53 adult patients with small bowel volvulus over a 15-year period with reference to the etiology, presentation, and survival. Patients and MethodsThe clinical details of 53 patients presenting with small bowel volvulus during the 15-year period from

Primary Midgut Volvulus in Adults: Report of Two Cases and Review of the Literature

“…[1][2][3] Midgut volvulus can be primary, without finding any associated underlying cause, or secondary to other congenital or acquired conditions. It is frequent in geographical areas, such as Middle East, Asia, and Central Africa, related to factors such as lower socioeconomic status, fiber consumption after prolonged fasting (Muslims during the Ramadan), parasitic infections and diabetic autonomous neuropathy, while it has a low incidence in Western countries.…”

Laparoscopic Management of a Primary Small Bowel Volvulus

“…1,2,4 However, no particular dietary factors were pointed out in other reports. 13,14 Nomura et al 13 suggested that the large volume of air in the intestine and the strong peristalsis resulting from frequent swallowing of air may be an etiologic factor. Another author noted that with the abrupt transit of a bulky semisolid meal into the proximal jejunum, there was a natural migration of this heavier segment of intestine into the left lower quadrant, which forces the distal empty loops into a clockwise rotation into the right upper quadrant.…”

“…Another author noted that with the abrupt transit of a bulky semisolid meal into the proximal jejunum, there was a natural migration of this heavier segment of intestine into the left lower quadrant, which forces the distal empty loops into a clockwise rotation into the right upper quadrant. 14 The preoperative diagnosis of primary small bowel volvulus is rather difficult. Plain abdominal films, CT scans, barium swallows, and angiography are usually used for the preoperative diagnosis of this condition.…”

The Noble plication: new indication for a historical procedure

“…If used, angiography can exhibit spiralling, twisted arterial branches originating off the superior mesenteric artery producing the characteristic 'barber pole' sign [11]. SBV has an overall mortality of 10%-47% [12], but a significantly higher mortality in patients with gangrenous bowel (20%-100%) [11].…”