Primary small bowel volvulus: A case report and literature review

BACKGROUND: Small bowel volvulus (SBV) is an aberrant rotation of the small bowel segment along the axis of its mesentery. Secondary SBV is the most frequent situation. Postoperative adhesions represent the main cause. On the other hand, primary SBV is an extremely rare situation. There are no predisposing anatomical abnormalities. Herein, we present a case of a 73-year-old-patient, with no surgical history, presenting primary SBV. CASE PRESENTATION: A 73-year-old-patient presented to the emergency department with a one-day history of acute abdominal pain and vomiting. He had no medical comorbidities and no previous abdominal surgery. On examination, he was agitated and afebrile. Urgent computed tomography (CT) scan showed dilated small bowel loops with a “whirl sign”. A laparotomy was performed. It revealed a 320° SBV of the distal jejunum and the proximal ileum. The small bowel was ischemic. There were no congenital malformations, no adhesions, and no internal hernia. We performed a detorsion of the small bowel. It regained good vitality. To avoid recurrence, we performed enteropexy of the terminal ileum, and the caecum to widen the mesenteric base. We noted no recurrence of the pathology after three months of follow-up. CONCLUSION: Primary SBV is an extremely rare situation. Physiopathology is still misunderstood. The clinical presentation is not specific. Diagnosis can be evoked by CT scan but can only be confirmed intraoperatively. The surgical treatment should be performed timely. Different techniques have been described to avoid recurrence. None of those techniques is consensual.