腸管・腸間膜固定術にて治癒した原発性小腸軸捻転症の１例

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  • A CASE OF PRIMARY SMALL BOWEL VOLVULUS SUCCESSFULLY TREATED WITH FIXATION OF THE BOWEL AND MESENTERY

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A 74-year-old woman who had been treated for abdominal pain of unknown origin for 5 years was seen at the hospital because of abdominal pain. There were previous histories of undergoing appendec-tomy and total gastrectomy. Abdominal CT scan disclosed whirl sign, which means a condition that the small intestine winds round a mesenteric vessel like a whirl, and small intestinal volvulus was diagnosed. Symptomatic remission was gained by conservative therapy and patient was discharged from the hospital however, she was seen at the hospital again because of abdominal pain. Abdominal CT scan gave the diagnosis of small intestinal volvulus again. Laparotomy to reduce the volvulus disclosed that the ileum was twisted counterclockwise by 180 degree and no ischemic changes were seen in the small intestine. We considered that the volvulus was not caused by adhesion, abnormal cord, or malrotation of intestine, and diagnosed the case as primary small intestinal volvulus. After the volvulus was reduced and the small intestines were sutured and fixed each other, a balloon-tip catheter was inserted into the mesentery to fix it, as the terminal of the catheter was put out from the abdominal wall. Then the operation was completed. The patient's postoperative course was uneventful. After discharge the catheter was romoved in the clinic. No recurrence has occurred thereafter.

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