Small Bowel Volvulus In Adult: A Review Of Literature


  •   Devajit Chowlek Shyam

  •   Ranjit Chowlek Shyam


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.

Keywords: Volvulus, small bowel Volvulus, whirl sign, bowel necrosis


C. L. N. Tsang, C. T. Joseph, M. S. B. De Robles, S. Putnis, “Primary Small Bowel Volvulus: An Unusual Cause of Small Bowel Obstruction”, Cureus, vol.11 (12), pp. 6465, 2019.

A. Wright, S. Chong, J. Willatt, “Small bowel volvulus around caesarian section scar adhesions”, Radiol Case Radiol., vol. 12(3), pp. 504–507, 2017.

J. J. Leow, T. Huey, J. K. Low, “Primary adult midgut volvulus mimicking acute appendicitis: a case report and review of the literature”, Int J Surg Case Rep., vol. 24, pp. 182–184, 2016.

M. Kapadia, “Volvulus of the small bowel and colon”, Clin Colon Rectal Surg., vol. 30(1), pp. 40–45, 2017.

S. Islam, D. Hosein, D. Dan, V. Naraynsingh, “Volvulus of ileum: A rare cause of small bowel obstruction”. BMJ Case Reports, vol. 19, 2016.

X. F. Shen, W. X. Guan, K. Cao, H. Wang, J. F. Du, “Small bowel volvulus with jejunal diverticulum: Primary or secondary?”, World J Gastroenterol, vol. 21(36), pp. 10480-10484, 2015.

J. S. Bhullar, P. Papapetrou, G. Subhas, N. Gupta, S. Seman, V. K. Mittal, “Spontaneous Resolution of Primary Small Bowel Volvulus with Oral Contrast”, J Curr Surg, vol. 2(3), pp. 110-112, 2012.

E. P. Burke, M. Saeed, M. Mahmood, C. Hayes, M. Salama, and I. Ahmed, “Whirl Sign and Midgut Volvulus: An Unusual Cause of an Acute Abdomen in an Adult Patient”, Case Reports in Surgery, 2019.

Z. M. Bauman, C. H. Evans, “Volvulus”, Surg Clin North Am., vol. 98 (5), pp. 973-993, 2018.

D. Gingold, Z. Murrell, “Management of colonic volvulus”, Clin Colon Rectal Surg., vol. 25, pp. 236–244, 2012.

J. Klein, K. Baxstorm, S. Donnelly, et al. “A fatal twist: volvulus of the small intestine in a 46 year old woman”, Case Rep Med. 2015; Article ID 391093:4.

M. Takatsuka, M. A. Shah, B. Dharmarajah, R. Brightwell, N. Damani, “A rare case of adult primary jejunal volvulus”, BMJ Case Rep. 2010; doi: 10.1136/bcr.09.2009.2242.

E. Valsdottir, J. H. Marks, “Volvulus: small bowel and colon”, Clin Colon Rectal Surg, vol. 21, pp. 91–93, 2008.

A. Roggo, L. W. Ottinger, “Acute small bowel volvulus in adults. A sporadic form of strangulating intestinal obstruction”, Ann Surg, vol. 216(2), pp. 135-141, 1992.

M. A. Brinda, S. Manjunath, K. S. Balasubramanya, B. Nanjaiah, “An unusual case of small bowel volvulus”, J Clin Diagn Res, vol. 9, pp. 8–10, 2015.

T. Patial, S. Chaddha, N. Rathore, V. Thakur, “Small Bowel Volvulus: A Case Report”, Cureus, vol. 9(5), pp. 1281, 2017.

P. G. Katis, S. M. Dias, “Volvulus: a rare twist on small- bowel obstruction” CMAJ, vol., 171 (7), pp. 728, 2004.

X. Li, J. Zhang, B. Li, D. Yi, C. Zhang, N. Sun et al. “Diagnosis, treatment and prognosis of small bowel volvulus in adults: A monocentric summary of a rare small intestinal obstruction”, PLoS ONE. 2017; 12(4). e 0175866. Doi:10.1371/journal.pone.0175866.

D. Jaramillo, B. Raval, “CT diagnosis of primary small-bowel volvulus”, AJR Am J Roentgenol, vol. 147(5), pp. 941–942, 1986.

J. D. Wig, S. M. Bose, S. P. Kaushik, “Volvulus obstruction of the small andlarge bowels”, J Postgrad Med, vol. 24, pp. 117-120, 1978.

Q. Cong, X. Li, X. Ye, L. Sun, W. Jiang, Z. Han et al. “Small bowel volvulus in mid and late pregnancy: can early diagnosis be established to avoid catastrophic outcomes?”, Int J Clin Exp Med, vol. 7, pp. 4538–4543, 2014.

C. H. Li, C. H. Chen, J. W. Chou, “Intestinal obstruction caused by small bowel volvulus”, Am J Med, vol.124, pp. 3-4, 2011.

D. J. Birnbaum, E. Grègoire, P. Campan, J. Hardwigsen, Y. P. Le Treut, “Primary small bowel volvulus in adult”, J Emerg Med, vol. 44, pp. 329–330, 2013.

T. M. Coe, D. C. Chang, J. K. Sicklick, “Small bowel volvulus in the adult populace of the United States: results from a population-based study”, Am J Surg, vol. 210, pp. 201–210, 2015.

U. Aydin, P. Yazici, H. Toz, C. Hoscoskun, A. Coker, “Management of small bowel volvulus in a patient with simultaneous pancreas-kidney transplantation a case report”, Journal of Medical Case Reports, vol. 1, pp. 106, 2007.

К. Inukai, Н. Kitagami, S. Uehara, “A rare case of secondary small bowel volvulus laparoscopically repositioned: literature review and classification”, Surgical Case Reports, vol. 4(1), pp. 65, 2018.

J. H. Ryu, H. J. Yang, G. Lee, Y. S. Lim, J. K. Kim, E. Ryoo et al. “Small bowel volvulus in adults: A case report”, J Korean Soc Emerg med. vol. 13(3), pp. 373-376, 2002.

M. Y. Hong, C. H. Chi, “Small-Intestinal Volvulus”, N Engl J Med. vol. 365(4), pp. 358, 2011.

T. Shepherd, A. Teo, R. Naunton-Morgan, “Orthodontic braces come back to bite: a novel presentation of a small bowel volvulus”, BMJ Case Rep. 2017; 2017: bcr2017221152.

M. Lepage-Saucier, A. Tang, J. S. Billiard, J. Murphy-Lavallée, L. Lepanto, “Small and large bowel volvulus: Clues to early recognition and complications”, Eur J Radiol. vol. 74, pp. 60–66, 2010.

Y. Kitano, K. Hashizume, M. Ohkura, “Segmental small-bowel volvulus not associated with malrotation in child hood”, Pediatr Surg Int., vol. 10, pp. 335–338, 1995.

K. Ghebrat, “Seasonal variation of primary small intestinal volvulus in North West Ethiopia”, East Cent Afr J surg, vol. 6, pp. 87-90, 2001.

J. H. Duke, M. S. Yar, “Primary small bowel volvulus. Cause and management”, Arch. Surg.vol. 112(6), pp. 685-688, 1977.

N. Ali, M. Mubarak, Y. Ali, “Primary volvulus of the small intestine”, Ann Nigerian Med., vol. 7, pp. 86–89, 2013.

I. O. McDonald, D. B. Hawker, “Small bowel volvulus: the commonest abdominal emergency in Nepal”, Bristol Med Chir J, vol. 95, pp. 4–8, 1980.

E. Christensen, “Volvulus of Small Bowel Diagnosed Pre-operatively”, Br Med J., vol. 1, pp. 442, 1958.

J. Santín-Rivero, E. Núñez-García, M. Aguirre-García, G. Hagerman-Ruiz-Galindo, F. de la Vega-Gonzalaz, C. R. Moctezuma-Velasco, “Intestinal volvulus. Case report and a literature review”, Cir Cir, vol. 83, pp. 522-526, 2015.

G. Papadimitriou, A. Marinis, A. Papakonstantinou, “Primary midgut volvulus in adults: report of two cases and review of the literature”, J Gastrointest Surg.vol. 15, pp. 1889–1892, 2011.

B. W. C. Ferris, “Small bowel volvulus post gastric bypass”, Int Surg J. vol. 6(2), pp. 590-592, 2019.

P. G. Jackson, M. T. Raiji, “Evaluation and management of intestinal obstruction”, Am Fam Physician, vol. 83(2), pp. 159–165, 2011.

C. M. Peterson, J. S. Anderson, A. K. Hara, J. W. Carenza, C. O. Menias, “Volvulus of the gastrointestinal tract: appearances at multimodality imaging”, RadioGraphics, vol. 29(5), pp. 1281–1293, 2009.

P. J. Strouse, “Disorders of intestinal rotation and fixation (“malrotation”)”, Pediatr Radiol, vol. 34, pp. 837-851, 2004.

S. M. Bernstein, P. D. Russ, “Midgut volvulus: a rare cause of acute abdomen in an adult patient’, Am J Roentgenol, vol. 171(3), pp. 639-641, 1988.

P. E. Constanthin, M. Darouichi, “Volvulus of the small bowel due to malrotation during pregnancy: A case report”, Journal of digestive disorders and diagnosis, vol. 1(3), pp. 34-40, 2017.

B. Barakat, R. Pezzilli, “Volvulus of ileum: A rare case of small bowel obstruction and the effectiveness of abdominal ultrasound imaging for the diagnosis”, Emergency Care Journal, vol. 15(2), pp. 8154, 2019.

A. Khan, F. Khan, K. Rafique, S. Khan, A. Majid, K. Khan et al. “Small Gut Volvulus, A Rare Twist, In The Setting Of An Even Rarer Entity; Multiple Giant Jejuno Ileal Diverticula”, J Ayub Med Coll Abbottabad, vol. 29(1), pp.147-149, 2017.

C. H. Talbot, “Volvulus of the small intestine in adults”, Gut, vol. 1, pp.76-80, 1960.

T. M. S. Salama, “Laparoscopic Management of Acute Intestinal Obstruction’, Surgery Curr Res, vol. 7, pp. 290, 2017.

M. J. Martin, S. R. Steele, “Twists and turns: a practical approach to volvulus and intussuception”, Scand J Surg, vol. 99, pp. 93–102, 2010.

K. H. Kim, M. C. Kim, S. H. Kim, K. J. Park, G. J. Jung, “Laparoscopic management of a primary small bowel volvulus: a case report”, Surg Laparos Endosc Percutan Tech, vol. 17, pp. 335–338, 2007.


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How to Cite
Shyam, D., & Shyam, R. (2020). Small Bowel Volvulus In Adult: A Review Of Literature. European Journal of Medical and Health Sciences, 2(3).