A CASE OF PRIMARY VOLVULUS OF THE SMALL BOWEL DIAGNOSED EARLY BY CHARCTERISTIC CT FINDINGS

A 26-year-old man had a sudden onset of epigastric pain after a lunch. He was seen at the our hospital in the evening because of a hard pain. He had the same pain twice previously which improved by conservative therapy. Physical examination revealed severe tenderness in the epigatric area without peritoneal sign. Abdominal CT demonstrated a whirl mass involving the small bowel and mesenterium around the superior mesenteric artery. The patient was diagnosed as having small bowel volvulus and underwent an emergency operation 3 hours after he consulted. During surgery it was found that the small bowel from about 90cm of Treitz ligament to the ileo-cecal part twisted clockwise by 900° (2.5 turns). The dark small bowel color turned out pinkish by canceling the volvulus. Further, multiple jejunum diverticula were found in the oral side of the volvulus, which were resected partialy. Small bowel volvulus in adults is very are and few cases are able to be diagnosed preoperatively. We have successfully diagnosed it preoperatively by characteristic CT finding.