Distal ileal volvulus leading to intestinal obstruction: A case report

Small bowel volvulus (SBV) involves the abnormal twisting of a small bowel loop around its mesenteric axis, often causing intestinal obstruction. It is rare in Western countries but accounts for up to 20-35 % of small bowel obstruction (SBO) cases in Asia, Africa, and the Middle East due to dietary and environmental factors. Non specific symptoms might lead to delayed diagnosis. Early diagnosis is crucial to prevent complications such as ischemia and necrosis.

A 52-year-old female presented with acute abdominal pain, nausea, vomiting, and absence of stool or flatus for three days. Imaging revealed SBO features but was inconclusive. Conservative management was initiated but failed as symptoms worsened. Exploratory laparotomy revealed distal ileal volvulus with gangrenous bowel. Surgical intervention included bowel resection, right hemicolectomy, proximal ileostomy, and distal mucous fistula. The patient recovered well postoperatively and was discharged in stable condition.

SBV is a rare but critical SBO cause, requiring prompt recognition and surgical management. Non-specific clinical and imaging findings complicate diagnosis. This case emphasizes the importance of considering SBV in acute abdomen cases and highlights exploratory laparotomy's role in both diagnosis and management. Individualized surgical strategies are crucial.

Although distal ileal volvulus is rare, it should be considered in SBO differential diagnoses. Early intervention reduces complications. Robust diagnostic protocols and reporting are essential to improve management of this uncommon condition.