Primary volvulus of the small intestine in an adult, and review of 15 other cases from the Japanese literature

We report case of primary volvulus of the small intestine and review 15 cas es from the Japanese literature. A 56-year-old woman, with a history of app endectomy 30 years previously, was admit ted with abdominal distension and signs of peritonitis. Abdominal computed tomography (CT) demonstrated a whi rl-like pattern of the mesentery, showing the tightly twisted mesentery aro und the point of torsion. An emergency laparotomy revealed strangulation of the small intestine, from 200 cm anal to the Treitz ligament to 5 cm oral to the terminal ileum, caused by 360 degrees clockwise torsion. There was n o adhesion caused by the previous operation nor were there any congenital a nomalies. The strangulated intestine was removed and jejuno-colonostomy was performed. The patient was discharged from hospital on day 39 after the op eration. Primary volvulus of the small intestine was reported to be rare in Japan, but the mortality was 26%. Immediate diagnosis and surgical interve ntion is essential to achieve a good outcome. A whirl-like pattern of the m esentery is a typical sign of this condition on CT.