SMALL-BOWEL VOLVULUS - A COMMON-CAUSE OF MECHANICAL INTESTINAL-OBSTRUCTION IN OUR REGION

Objective: To find out the incidence and causes of small bowel volvulu s 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 operat ed on for mechanical intestinal obstruction caused by small bowel volv ulus. Main outcome measures: Incidence of small bowel volvulus, detail s of patients, treatments, complications, and outcome. Results: Small bowel volvulus constituted 8%(38/466) of all cases of mechanical intes tinal obstruction and 13%(38/292) of small bowel obstruction. Volvulus was primary in 18(47%), and secondary in 20(53%) patients. 33 Patient s (87%) were male. The mean age of the whole group was 30 years, 42 an d 19 in patients with primary and secondary volvulus, respectively (p = 0.0005). The incidence of small bowel volvulus was 19%(27/143) in pa tients 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) w ere under 20 years of age compared with 17% of those with primary volv ulus (3/18; p = 0.009). The causes of secondary volvulus were Meckel's diverticulum in 14 patients (70%), and malrotation and ileosigmoid kn otting 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 s eptic shock. Conclusions: Small bowel volvulus is a common form of int estinal obstruction in our region. It carries a high risk of gangrene of twisted segments of bowel. Fortunately perforation of small bowel i s uncommon, and resection and primary anastomosis is a safe procedure in cases of necrosis. Today the outcome of such patients is satisfacto ry. Early and proper management is essential for a good outcome.