Small Bowel Volvulus in Adults at University of Uyo Teaching Hospital: A Six Year Review

Small bowel volvulus in adults is rare and occurs more frequently in Asia and Africa than the Western world. We reviewed 12 cases of adult small bowel volvulus treated over a 6 year period as well as its presentation and management at the University of Uyo Teaching Hospital, Uyo, Nigeria. The records of patients with small bowel volvulus seen at University of Uyo Teaching Hospital from January 2007 to April 2013 were reviewed retrospectively. Consecutive adult patients confirmed intra-operatively were included while those without intra-operative confirmation and children were excluded. Twelve adult patients presented with small bowel volvulus confirmed intra-operatively. Male to female ratio was 2:1. Age range was 17 to 61 years (mean 33.0 years). The ratio of primary to secondary types was 3:1, four patients (33.3%) had gangrenous bowel, 9 patients (75.0%) had incidental finding of slightly mobile caecum and 3 patients (25.0%) also had coexisting inflamed appendix. Surgical procedures carried out include right hemi-colectomy in 3 patients (25.0%), resection and anastomosis of small intestines in 2 patients (17.0%), detortion/adhesiolysis with appendicectomy in 3 patients (25.0%), and detortion/adhesiolysis only in 3 patients (25.0%). Three patients that had right hemi-colectomy also had slightly mobile caecum. Six other patients with mobile caecum also had caecopexy in addition to other procedures. Four patients (33.3%) had superficial surgical site infection (SSSI), one patient (8.3%) had postoperative bowel gangrene. One patient died giving a mortality rate of 8.3%. Small bowel volvulus is an unusual cause of intestinal obstruction associated with relatively high mortality, requiring early operative intervention to improve outcome.