Gastrointestinal motility should be emphasized after laparotomy treatment for complete small intestinal volvulus in older adults

Abstract

Rationale:Complete small intestinal volvulus is a rare entity in adults, unlike partial intestinal volvulus. Although prompt surgical intervention is the mainstay of treatment, attention should also be paid to recovery of intestinal function postoperatively. Ignoring this issue during the postoperative recovery process can have serious consequences. We report the case of an 82-year-old woman with complete small intestinal volvulus at the root of the superior mesenteric vessel.Patients concerns:The patient was admitted for acute onset (22 hours) of abdominal pain and distention. Nausea and vomiting also developed during this period.Diagnoses:Abdominal physical examination was suspicious for peritoneal irritation. Computed tomography scan showed anticlockwise swirl of the mesenteric vessels at the lower margin of the pancreas with distension of the entire small intestine. A complete small intestinal volvulus was diagnosed.Interventions:Laparotomy and detorsion of the volvulus were performed after early diagnosis.Outcomes:The patient developed intestinal wall edema because of ischemic–reperfusion damage. She exhibited severe abdominal distention and absent intestinal motility. Two days later, she went into septic shock; she died 19 days after surgical intervention.Lessons:Because complete small intestinal volvulus involves the entire intestine, ischemic–reperfusion intestinal damage after detorsion may be severe and can predict prognosis.