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[Jejuno-ileal volvulus, a rare cause of intestinal obstruction].

Volvulus of the small bowel without predisposing anatomical defects is a rare cause of acute intestinal obstruction in the Western world, and its incidence is decreasing in Europe and America, although it is common in others parts of the world. The causes of primary volvulus of the small bowel and the mechanism of rotation of the entire root of the mesentery remain unexplained. Several anatomical and dietary factors have been implicated. This theory requires strong peristalsis, tense, firm abdominal muscles and feeding pattern of very bulky meals taken at long intervals. In the present case, a large quantity of bulky poorly digested food consumed previously, and strong abdominal muscles are in keeping with the above theory.

Abdominal Muscles↗

Intestinal malrotation without volvulus in infancy and childhood.

Intestinal malrotation without volvulus in infants and children is often difficult to diagnose because of less dramatic clinical features, e.g. failure to thrive and intermittent bile stained vomiting, compared to the patients with volvulus. A plain x-ray of the abdomen may show the characteristic "double bubble sign", otherwise a barium meal will give the diagnosis. A follow-up study of 18 patients of whom 14 had an operation showed that all but one were free of symptoms after a median observation period of 205 months (range 20-317). It is concluded that any patient presenting with a symptomatic intestinal malrotation should be offered an operation except for the type with a mobile caecum.

Female↗