Case report: small bowel volvulus following laparoscopic-assisted Soave pull-through for adult Hirschsprung disease:...

Small bowel volvulus (SBV) is the twisting of a small bowel loop around its mesentery, leading to closed-loop intestinal obstruction. SBV following laparoscopic procedures is a rare complication. Patients often present with non-specific symptoms, creating a diagnostic dilemma and delaying surgical intervention. A high index of suspicion and timely imaging are essential. Understanding the mechanisms, risk factors, clinical presentation, and management is paramount.

A 21-year-old woman with a confirmed diagnosis of adult Hirschsprung disease underwent laparoscopic-assisted Soave pull-through with protective loop ileostomy. On the 2nd postoperative day, she developed signs and symptoms of small bowel obstruction (SBO). Exploratory laparotomy revealed a 720° SBV proximal to the ileostomy with areas of patchy ischemia. Derotation was performed, and the patient was discharged in stable condition after 5 days. She is currently recovering smoothly and awaiting ileostomy reversal.

SBV is an uncommon but serious complication following laparoscopic surgery. Mechanisms remain unclear, though pneumoperitoneum, adhesions, and bowel mobility are implicated. Presentations are non-specific, requiring vigilance and early imaging to ensure prompt diagnosis and intervention.

Post-laparoscopic SBV is rare but potentially life-threatening. Timely recognition, diagnosis, and surgical management are essential to prevent morbidity and mortality.