A Case of Primary Volvulus of Small Intestine That Computed Tomography was Effective for Preoperative Diagnosis

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  • 術前診断にＣＴ検査が有用であった原発性小腸軸捻転症の１例

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We report a rare case of primary volvulus of the small intestine. A 18-year-old man with no past history of laparotomy was admitted for worsening abdominal pain. Enhanced abdominal computed tomography (CT) revealed a so-called “whirl sign” indicating rotation of the small intestine and mesenterium around the superior mesenteric artery, and edematous wall thickening of the small intestine with ischemic change, which prompted us to perform an emergency operation. Almost all of the small intestine was found to be twisted clockwise by 360° at the root of the superior mesenteric artery. Without predisposing anatomical abnormalities, we diagnosed primary volvulus of the small intestine. The small intestine had not necrosed, so surgery involved only relieving the twist. The postoperative course was favorable and he was discharged on day 10 after the operation. The preoperative diagnosis of this disease is considered to be difficult, but the enhanced abdominal CT findings of a “whirl sign” and ischemic change of the small intestine were useful in diagnosis of this case.

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