Volvulus of the small bowel: an uncommon complication after laparoscopic cholecystectomy

We report here two patients with volvulus of the small bowel after laparoscopic cholecystectomy (LC). There has been only one case report of a similar condition after LC in the English literature; the patient had malrotation of the midgut. Both patients we are reporting had previous pelvic surgery resulting in intraabdominal adhesions. Volvulus had occurred along an axis between the mesenteric attachment and the adhesion to the parietal peritoneum of the involved loop of small bowel. The creation of pneumoperitoneum could conceivably allow rotation to occur. One patient presented with signs of peritonitis from a gangrenous segment of small bowel. The other presented with continued abdominal pain after surgery. Definitive diagnosis was made only at laparotomy. Previous surgery is considered a relative contraindication to LC, although the incidence of morbidity and conversion to open procedure appear not to be influenced by previous surgery. Surgeons should be aware of volvulus as a complication after LC in patients who had previous abdominal surgery.