Small Bowel Volvulus In Adult: A Review Of Literature

Abstract

A Small bowel volvulus is a rare entity where the small bowel loop twists around its own mesentery. These twisting may produce a mechanical obstruction, vascular compromise, or both. In North America and Western Europe, the annual incidence of small bowel volvulus is 1.7 to 5.7 cases per 100,000, but much higher rates of 24 to 60 cases per 100,000 have been observed in Africa, Asia, the Middle East, and India. Small bowel volvulus can be classified as primary and secondary subtypes. In primary variety, there is no known cause whereas secondary variety occurs due to the presence of predisposing lesions, either congenital or acquired of which postoperative adhesion is the most common responsible factor. The most commonly accepted explanation for the initiation of primary small bowel volvulus is the abnormal bowel peristalsis generated due to the sudden overfilling of the empty bowel loop with a large portion of meal after prolong fasting. Secondary small bowel volvulus is commonly seen in the elderly population with mixed gender distribution. There are no specific clinical features or laboratory findings and a high index of suspicion is required to reach a diagnosis. Abdominal pain is the most common presenting feature of small bowel volvulus. CT scan is the investigation of choice and a whirl sign is the characteristic finding of bowel volvulus. Urgent Surgical exploration is the treatment of choice to prevent complications due to vascular compromise. Although small bowel volvulus is rare, it has a mortality rate between 9% and 35%, which can reach up to 100% if associated with bowel necrosis.