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PubMed1998

Small bowel volvulus: a common cause of mechanical intestinal obstruction in our region.

OBJECTIVE: To find out the incidence and causes of small bowel volvulus in our region, and to analyse the results of our management. DESIGN: Retrospective study. SETTING: Teaching hospital, Turkey. SUBJECTS: 38 Patients who had had no previous abdominal operations who were operated on for mechanical intestinal obstruction caused by small bowel volvulus. MAIN OUTCOME MEASURES: Incidence of small bowel volvulus, details of patients, treatments, complications, and outcome. RESULTS: Small bowel volvulus constituted 8%(38/466) of all cases of mechanical intestinal obstruction and 13%(38/292) of small bowel obstruction. Volvulus was primary in 18 (47%), and secondary in 20 (53%) patients. 33 Patients (87%) were male. The mean age of the whole group was 30 years, 42 and 19 in patients with primary and secondary volvulus, respectively (p=0.0005). The incidence of small bowel volvulus was 19%(27/143) in patients under 40 years, and 7%(11/149) in those over 40 years of age (p=0.005). Sixty percent of patients with secondary volvulus (12/20) were under 20 years of age compared with 17% of those with primary volvulus (3/18; p=0.009). The causes of secondary volvulus were Meckel's diverticulum in 14 patients (70%), and malrotation and ileosigmoid knotting in 3 patients each (15%). Segments of bowel were gangrenous in 12 patients (32%). Treatment was by simple untwisting in patients with viable segments of gut, or with resection of gangrenous segments and primary small bowel anastomosis. One patient died postoperatively of septic shock. CONCLUSIONS: Small bowel volvulus is a common form of intestinal obstruction in our region. It carries a high risk of gangrene of twisted segments of bowel. Fortunately perforation of small bowel is uncommon, and resection and primary anastomosis is a safe procedure in cases of necrosis. Today the outcome of such patients is satisfactory. Early and proper management is essential for a good outcome.

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