Idiopathic small bowel volvulus in an adult without prior surgery: a case report

Small bowel volvulus (SBV) is a rare but potentially life-threatening surgical emergency if not detected and treated on time. Primary or idiopathic SBV, occurring in the absence of any predisposing anatomical lesion, remains an uncommon clinical entity, especially in adults, accounting for a very small percentage of small bowel obstructions (SBOs) in non-volvulus-endemic regions and presenting a diagnostic challenge due to its nonspecific symptoms, lack of prior surgical history, or obvious risk factors.

We report a case of a 30-year-old African man with 3 days of bowel obstruction symptoms, no prior surgical history, and clinical findings of agitation, fever, tachycardia, mild tachypnea, neutrophilia, leukocytosis, and severe hemoconcentration. Imaging revealed multiple air-fluid levels and a "sigma sign" without free air. Emergency laparotomy identified an ischemic small bowel forming a 40-cm closed loop, twisted clockwise by 360° along the mesentery, 92 cm from the ileo-cecal junction.

Although idiopathic, primary SBV has been linked to dietary and cultural habits, such as the sudden consumption of large meals after fasting, and lifestyle factors, including heavy alcohol consumption and smoking, which may alter visceral motility. Given the limited literature on SBV in a virgin abdomen, adherence to available guidelines remains crucial.

Idiopathic SBV in adults without prior surgery is rare and diagnostically challenging, often presenting with nonspecific symptoms. Clinical vigilance and prompt surgical intervention remain essential, as imaging should not delay treatment in critically ill patients. Systematic documentation of such cases is needed to better define risk factors and strategies for recurrence prevention. In the present case, timely surgery led to a favorable postoperative recovery.