Postmortem Diagnosis of Primary Small Bowel Volvulus in an Adult

Abstract

Small bowel volvulus is a rare cause of intestinal obstruction. It is defined as the twisting of a segment of the bowel around the axis of its mesentery. Based on the cause, small bowel volvulus is divided into primary and secondary types. The primary type occurs in an otherwise normal abdominal cavity. The secondary type occurs in the presence of predisposing lesions, either congenital or acquired. This is a case report of a primary jejunal volvulus in an 82-year-old man who died suddenly. The autopsy findings included proximal small bowel obstruction and perforation with florid peritonitis secondary to jejunal volvulus. Histology confirmed infarction of the small bowel at the level of the jejunum. We concluded that the cause of death was peritonitis due to small bowel perforation caused by small bowel obstruction secondary to volvulus. No predisposing anatomical abnormality was identified at the site of the volvulus so, by definition, this is a primary type. Jejunal location is usually associated with primary volvulus, and these correlate with a higher incidence of necrotic loops requiring intestinal resection. Primary volvulus is more common in the jejunum than other parts of the small bowel, and these cases are more likely to result in necrosis requiring resection.