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Small bowel volvulus among adults.

Huang JC, Shin JS, Huang YT, Chao CJ, Ho SC, Wu MJ, Huang TJ, Chang FJ, Ying KS, Chang LP

Division of Gastroenterology, Department of Internal Medicine, Cheng-Ching General Hospital, Taichung, Taiwan. guthuang@yahoo.com.tw

BACKGROUND: To elucidate clinical experience associated with rare cases of small bowel volvulus among adults, we conducted a retrospective study. METHODS: From January 1993 to March 2003 inclusively, we reviewed the presentation and management of 19 patients featuring small bowel volvulus. All study-included patients underwent surgical treatment to confirm their diagnosis. We also analyzed their signs, symptoms, radiological examination details, clinical course and surgical results. RESULTS: The mean age of the study-included 19 patients (13 males, six females) was 61.3 years (range = 16-83 years). All patients suffering from small bowel volvulus were categorized as displaying either primary (no obvious predisposing factors) or secondary volvulus (specific predisposing anatomical abnormalities present). Among them, nine patients were categorized as having primary volvulus, and the remaining 10 were patients with secondary volvulus; this comprised one pregnancy, two malignant stromal tumors of the jejunum, six jejunal diverticula, and one adhesion band. Nine examples of volvulus occurred in the jejunum, four in the ileum, and six in both jejunum and ileum. There were five examples of a counter clockwise rotation of small bowel volvulus. Two patients exhibited bowel wall gangrene, both of whom died subsequent to surgery. The overall mortality rate was 11%. CONCLUSIONS: Although small bowel volvulus is rarely seen among adults, when a patient presents with intestinal obstruction, the possibility of small bowel volvulus must be considered. Early surgical intervention should be undertaken in order to prevent vascular compromise.

Published 12 December 2005 in J Gastroenterol Hepatol, 20(12): 1906-12.
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