Small-bowel volvulus

Loop of bowel is twisted more than 180 degrees about its axis, and is caused by mismatch of bowel length to narrow area of attachment.

Ileocolic most frequent in small bowel, but can occur in small bowel alone.

Endoscopic decompression is generally not useful (unlike sigmoid volvulus).

Use laparotomy to decompress volvulus, and either perform cecopexy, or preferably, resect the involved segment.

Primary small-bowel volvulus is common in countries where the diet is high in bulk.

• Neonatal variety (associated with malrotation), it is rare in the United States. If a small-bowel resection is required, it is usually of a limited nature.

Small-bowel volvulus secondary to adhesions is more common. The ileum is more frequently involved than the jejunum.