Intestinal volvulus, Midgut volvulus, Adults

Introduction: Rotation of the small bowel around its mesenteric vascular pedicle is termed midgut volvulus. This abnormality frequently causes obstruction and, most importantly, compromises the intestinal blood flow, threatening bowel viability. Midgut volvulus can be primary without findings of any associated underlying cause, or secondary to other congenital or acquired conditions. Primary midgut volvulus is more frequent in children and young adults and rarely presents in adults, among whom secondary volvulus is more prevalent. Case presentation: This is a case report of a 51-yearold male patient admitted to our surgical department with acute abdomen. Plain abdominal radiograph showed signs of bowel obstruction, while computed tomography demonstrated a rotation of the mesentery of the proximal jejunum with the characteristic “whirl” sign. The patient underwent an exploratory laparotomy, which revealed a midgut volvulus without any associated obvious cause or other pathology. The bowel was untwisted, and intestinal viability was confirmed. The postoperative course was uneventful, and normal bowel function was restored after 72 hours. The patient was discharged 10 days after the operation. Conclusions: Clinical presentation is usually nonspecific. The patient can present with an abrupt onset of signs and symptoms of small bowel obstruction, preceded by colicky epigastric or periumbilical pain, without a history of abdominal surgery or signs of any other obvious causes (hernias). “Pain out of proportion” as seen in acute mesenteric ischaemia and signs of systemic inflammatory response (tachycardia, fever, tachypnoea and leukocytosis) or periA. Marinis (Corresponding author), E. Liarmakopoulos, P. Dikaiakos, Ch. Markakis, P. Basioukas, S. Rizos First Department of Surgery, “Tzaneion” General Hospital, Piraeus, Greece e-mail: [email protected] tonitis should raise suspicion of evolving intestinal ischaemia. Clinical suspicion of small bowel volvulus demands urgent operative intervention, due to the associated risk of intestinal ischaemia. Untwisting of the involved bowel is frequently the only manoeuvre required, although some authors recommend intestinal fixation or even resection in order to avoid a recurrence of the volvulus.