Novel operative management of primary mesenteric volvulus

[Intestinal volvulus. Case report and a literature review]

BACKGROUND

Small bowel volvulus is a rare cause of intestinal obstruction in adult patients. This disease is more common in children and its aetiology and management is different to that in adults.

CLINICAL CASE

A 30 year-old male with sarcoidosis presents with acute abdomen and clinical data of intestinal obstruction. Small bowel volvulus is diagnosed by a contrast abdominal tomography and an exploratory laparotomy is performed with devolvulation and no intestinal resection. In the days following surgery, he developed a recurrent small bowel volvulus, which was again managed with surgery, but without intestinal resection. Medical treatment for sarcoidosis was started, and with his clinical progress being satisfactory,he was discharged to home.

CONCLUSIONS

Making an early and correct diagnosis of small bowel volvulus prevents large intestinal resections. Many surgical procedures have been described with a high rate of complications. Therefore, conservative surgical management (no intestinal resection) is recommended as the best treatment with the lowest morbidity and mortality rate.

The Noble plication: new indication for a historical procedure

Complications following ileal pouch-anal anastomosis (IPAA) have been well-described in the literature. While rare, small bowel volvulus following IPAA has been described. We describe the successful use of the modified Noble plication in such a patient with small bowel volvulus about an elongated mesentery. This largely 'historical' technique is well-suited to manage small bowel volvulus, especially when non-resectional management is preferred.