A case of small intestinal volvulus recurrence

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 73; no. 6; pp. 1407 - 1410
• Main Authors: OGAWA, Masao, IMAGAWA, Atsuo, DEMURA, Koichi, KAWASAKI, Masayasu, HORII, Katsuhiko, KAMEYAMA, Masao, YAMAUCHI, Michiko
• Format: Journal Article
• Language: English; Japanese
• Published: Japan Surgical Association 2012
• Subjects: jejunal diverticulum; recurrence; small intestinal volvulus
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.73.1407

A 97-year-old woman visited our hospital with chief complaints of vomiting and abdominal pain. Abdominal computed tomography (CT) showed a whirl sign in the small intestinal loop around the superior mesenteric artery (SMA). On the basis of this finding, we made a diagnosis of small intestinal volvulus. Emergency surgery revealed a 360° clockwise twist of the small intestine around the SMA and a solitary diverticulum (diameter, about 10 cm) at a distance of about 30 cm from the Treitz' ligament in the jejunum. We reduced axis rotations and performed wedge resection for the diverticulum. Forty-three days later, the patient revisited our hospital because of symptom recurrence. Abdominal CT showed a whirl sign, on the basis of which a diagnosis of recurrence of small intestinal volvulus was made. Emergency surgery revealed twisting of the small intestine similar to that observed the first time. Because there was no adhesion, we reduced axis rotations and performed mesentery fixation to prevent recurrence. Recurrence has been rarely reported, but additional procedures such as mesentery fixation have been suggested for the treatment of small intestinal volvulus.