Strangulative – ileus for primary small bowel volvulus in ten years old boy. A review of 15 cases in Japanese school-aged children
Introduction: The small bowel volvulus is classified into either, primary or secondary. The secondary small bowel volvulus with malrotation of intestine or intra-abdominal adhesion is relatively common in school-aged children. But the primary small bowel volvulus without these structured disease is rare, especially in Japan and Europe.
Case Report: The case is ten years old boy. He had vomiting, abdominal pain after lunch, so consulted a pediatrician. We might diagnose his illness as constipation at first, but abdominal pain were getting worse and his condition presented a shock state after hospitalization. The laboratory data and CT scan showed the strangulation ileus and the emergency operation was done. Small intestine twisted anti-clockwise 360° and necrotized widely. There are no structural disease and anatomic abnormalities, so we concluded the cause of intestinal necrosis was diagnosed as the primary small bowel volvulus. In Japan, a total of fifteen children with primary small bowel volvulus, including five girls and ten boys with the median age of eleven years old (7-14 years old). Among them, abdominal pain was the most common complaint (86%), followed by vomiting (80%). Severe continuous abdominal pain (53%) and circulatory disturbance (26%) are important symptoms that may predict strangulation. Diagnosis is difficult only by the symptom and laboratory data and X-rays, so often diagnosed by ultrasonography and CT scan. But ultrasonography did not lead to a diagnosis in these fifteen cases. The treatment is a volvulus release by the operation. In our study, resection accounted for 60% except two unknown cases.
Learning Points: The primary small bowel volvulus is difficult for physician to be diagnosed. Surgical management is often required because of necrosis by strangulation. So physician should consider it as one of the causes of acute abdomen.