Small bowel volvulus in association with recurrent Crohn's disease

The concomitant occurrence of Crohn's disease and small bowel volvulus is rare because of the serosal inflammation in the former disease causes adherence of the bowel to adjacent structures. A 61-year old female patient with ileocolitis developed 30 cm. of recurrent Crohn's disease in the ileum proximal to a previous ileosigmoidostomy. Following several episodes of small bowel obstruction she was found to have a small bowel volvulus which progressed to infarction. The possibility of volvulus should be considered in the differential diagnosis of a patient with granulomatous disease because of the danger of gangrene, perforation and peritonitis. Surgery should not be delayed in Crohn's disease if complete obstruction persists more than 24 hours, particularly if ischemia of the bowel cannot be ruled out.