Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1992 Aug;216(2):135–141. doi: 10.1097/00000658-199208000-00003

Acute small bowel volvulus in adults. A sporadic form of strangulating intestinal obstruction.

A Roggo 1, L W Ottinger 1
PMCID: PMC1242584  PMID: 1503517

Abstract

Small bowel volvulus is an uncommon but important cause of small intestinal obstruction. It often results in ischemia or even infarction. Delay in diagnosis and surgical intervention increases morbidity and mortality rates. Based on cause, small bowel volvulus can be divided into primary and secondary type. Goals for treatment of small bowel volvulus should include physician awareness of this uncommon diagnosis, accurate workup, and advanced surgical intervention. The presentation and subsequent management of 35 patients with small bowel volvulus confirmed by laparotomy are reviewed and discussed. The incidence of small bowel volvulus in the adult European and North American is low. The resultant mortality rate, however, makes diagnosis critically important. The cardinal presenting symptom is abdominal pain. There is no single specific diagnostic clinical sign or abnormality in laboratory or radiologic finding. In practice, the diagnosis can only be made by laparotomy. The failure to perform an exploratory laparotomy cannot be justified. Early diagnosis and early surgery are the keys for successful management of strangulation obstruction of the small bowel.

Full text

PDF
138

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Agrawal R. L., Misra M. K. Volvulus of the small intestine in Northern India. Am J Surg. 1970 Sep;120(3):366–370. [PubMed] [Google Scholar]
  2. Argov S., Itzkovitz D., Wiener F. A new method for differentiating simple intra-abdominal from strangulated small-intestinal obstruction. Curr Surg. 1989 Nov-Dec;46(6):456–460. [PubMed] [Google Scholar]
  3. Bizer L. S., Liebling R. W., Delany H. M., Gliedman M. L. Small bowel obstruction: the role of nonoperative treatment in simple intestinal obstruction and predictive criteria for strangulation obstruction. Surgery. 1981 Apr;89(4):407–413. [PubMed] [Google Scholar]
  4. Cathcart R. S., 3rd, Williamson B., Gregorie H. B., Jr, Glasow P. F. Surgical treatment of midgut nonrotation in the adult patient. Surg Gynecol Obstet. 1981 Feb;152(2):207–210. [PubMed] [Google Scholar]
  5. Cheadle W. G., Garr E. E., Richardson J. D. The importance of early diagnosis of small bowel obstruction. Am Surg. 1988 Sep;54(9):565–569. [PubMed] [Google Scholar]
  6. De Souza L. J. Volvulus of the small bowel. Br Med J. 1976 May 1;1(6017):1055–1056. doi: 10.1136/bmj.1.6017.1055. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Deutsch A. A., Eviatar E., Gutman H., Reiss R. Small bowel obstruction: a review of 264 cases and suggestions for management. Postgrad Med J. 1989 Jul;65(765):463–467. doi: 10.1136/pgmj.65.765.463. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Duke J. H., Jr, Yar M. S. Primary small bowel volvulus: cause and management. Arch Surg. 1977 Jun;112(6):685–688. doi: 10.1001/archsurg.1977.01370060017002. [DOI] [PubMed] [Google Scholar]
  9. Dunn J. T., Halls J. M., Berne T. V. Roentgenographic contrast studies in acute small-bowel obstruction. Arch Surg. 1984 Nov;119(11):1305–1308. doi: 10.1001/archsurg.1984.01390230071017. [DOI] [PubMed] [Google Scholar]
  10. Frazee R. C., Mucha P., Jr, Farnell M. B., van Heerden J. A. Volvulus of the small intestine. Ann Surg. 1988 Nov;208(5):565–568. doi: 10.1097/00000658-198811000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Goodman P., Raval B. CT diagnosis of acquired small bowel volvulus. Am Surg. 1990 Oct;56(10):628–631. [PubMed] [Google Scholar]
  12. Gulati S. M., Grover N. K., Tagore N. K., Taneja O. P. Volvulus of the small intestine in India. Am J Surg. 1973 Nov;126(5):661–664. doi: 10.1016/s0002-9610(73)80017-0. [DOI] [PubMed] [Google Scholar]
  13. Holder W. D., Jr Intestinal obstruction. Gastroenterol Clin North Am. 1988 Jun;17(2):317–340. [PubMed] [Google Scholar]
  14. Jaramillo D., Raval B. CT diagnosis of primary small-bowel volvulus. AJR Am J Roentgenol. 1986 Nov;147(5):941–942. doi: 10.2214/ajr.147.5.941. [DOI] [PubMed] [Google Scholar]
  15. Juler G. L., Stemmer E. A., Connolly J. E. Preoperative diagnosis of small bowel volvulus in adults. Am J Gastroenterol. 1971 Sep;56(3):235–247. [PubMed] [Google Scholar]
  16. Kaltiala E. H., Lenkkeri H., Larmi T. K. Mechanical intestinal obstruction. An analysis of 577 cases. Ann Chir Gynaecol Fenn. 1972;61(2):87–93. [PubMed] [Google Scholar]
  17. Laws H. L., Aldrete J. S. Small-bowel obstruction: a review of 465 cases. South Med J. 1976 Jun;69(6):733–734. doi: 10.1097/00007611-197606000-00021. [DOI] [PubMed] [Google Scholar]
  18. Leffall L. D., Syphax B. Clinical aids in strangulation intestinal obstruction. Am J Surg. 1970 Dec;120(6):756–759. doi: 10.1016/s0002-9610(70)80043-5. [DOI] [PubMed] [Google Scholar]
  19. MORETZ W. H., MORTON J. J. Acute volvulus of small intestine; analysis of 36 cases. Ann Surg. 1950 Nov;132(5):899–912. doi: 10.1097/00000658-195011000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Mucha P., Jr Small intestinal obstruction. Surg Clin North Am. 1987 Jun;67(3):597–620. doi: 10.1016/s0039-6109(16)44234-9. [DOI] [PubMed] [Google Scholar]
  21. Pain J. A., Collier D. S., Hanka R. Small bowel obstruction: computer-assisted prediction of strangulation at presentation. Br J Surg. 1987 Nov;74(11):981–983. doi: 10.1002/bjs.1800741107. [DOI] [PubMed] [Google Scholar]
  22. Renton C. J. Primary volvulus of small intestine. Br Med J. 1965 Sep 25;2(5464):743–743. doi: 10.1136/bmj.2.5464.743. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Rescorla F. J., Shedd F. J., Grosfeld J. L., Vane D. W., West K. W. Anomalies of intestinal rotation in childhood: analysis of 447 cases. Surgery. 1990 Oct;108(4):710–716. [PubMed] [Google Scholar]
  24. SILEN W., HEIN M. F., GOLDMAN L. Strangulation obstruction of the small intestine. Arch Surg. 1962 Jul;85:121–129. doi: 10.1001/archsurg.1962.01310010125017. [DOI] [PubMed] [Google Scholar]
  25. Saidi F. The high incidence of intestinal volvulus in Iran. Gut. 1969 Oct;10(10):838–841. doi: 10.1136/gut.10.10.838. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Sarr M. G., Bulkley G. B., Zuidema G. D. Preoperative recognition of intestinal strangulation obstruction. Prospective evaluation of diagnostic capability. Am J Surg. 1983 Jan;145(1):176–182. doi: 10.1016/0002-9610(83)90186-1. [DOI] [PubMed] [Google Scholar]
  27. Shatila A. H., Chamberlain B. E., Webb W. R. Current status of diagnosis and management of strangulation obstruction of the small bowel. Am J Surg. 1976 Sep;132(3):299–303. doi: 10.1016/0002-9610(76)90379-2. [DOI] [PubMed] [Google Scholar]
  28. Stewardson R. H., Bombeck C. T., Nyhus L. M. Critical operative management of small bowel obstruction. Ann Surg. 1978 Feb;187(2):189–193. doi: 10.1097/00000658-197802000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Tiwari V. S., Gupta H. C., Varma M. M., Garg R. K. Volvulus of the small intestine. Int Surg. 1982 Oct-Dec;67(4 Suppl):476–478. [PubMed] [Google Scholar]
  30. Vaez-Zadeh K., Dutz W., Nowrooz-Zadeh M. Volvulus of the small intestine in adults: a study of predisposing factors. Ann Surg. 1969 Feb;169(2):265–271. doi: 10.1097/00000658-196902000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Wapnick S. Treatment of intestinal volvulus. Ann R Coll Surg Engl. 1973 Jul;53(1):57–61. [PMC free article] [PubMed] [Google Scholar]
  32. Welch G. H., Anderson J. R. Volvulus of the small intestine in adults. World J Surg. 1986 Jun;10(3):496–500. doi: 10.1007/BF01655319. [DOI] [PubMed] [Google Scholar]
  33. Wiersma R., Hadley G. P. Small bowel volvulus complicating intestinal ascariasis in children. Br J Surg. 1988 Jan;75(1):86–87. doi: 10.1002/bjs.1800750130. [DOI] [PubMed] [Google Scholar]
  34. ZOLLINGER R. M., KINSEY D. L. DIAGNOSIS AND MANAGEMENT OF INTESTINAL OBSTRUCTION. Am Surg. 1964 Jan;30:1–5. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES