• Seito Shimizu, Hitoshi Hara, Yasuhide Muto, Tomoki Kido, and Ryohei Miyata.
• Department of Surgery, Social Welfare Organization Saiseikai Imperial Gift Foundation Inc., Saiseikai Kazo Hospital, Kazo, Japan.
• Medicine (Baltimore). 2024 Aug 16; 103 (33): e39391e39391.

RationaleSmall bowel volvulus (SBV) is a rare cause of acute abdominal pain in adults, which requires surgical intervention to prevent small bowel necrosis. Primary SBV is rare, and its preoperative diagnosis is challenging. This report describes a case of primary SBV diagnosed preoperatively and treated laparoscopically.Patient ConcernsA 56-year-old man presented complaining of sudden-onset abdominal pain of 3-hour duration. Physical examination revealed tenderness in periumbilical and upper abdominal regions with no signs of peritonitis.DiagnosisContrast-enhanced computed tomography revealed a 360°-clockwise rotation of the small intestine when viewed caudally at the mesenteric base. At this region, the superior mesenteric vein was interrupted. Although no dilation of the small intestine was observed, increased density in the mesentery of the affected area was observed. Minimal ascites was observed in the pelvic cavity. No evidence of congenital or secondary SBV was observed, supporting the diagnosis of primary SBV.InterventionsLaparoscopic detorsion of the SBV was performed approximately 6 hours after the onset of symptoms. No signs of bowel necrosis were observed, and the procedure was concluded after releasing the torsion.OutcomesSevere abdominal pain disappeared immediately after surgery. The postoperative course was uneventful, and the patient was discharged on the 8th postoperative day.LessonsThis case highlights the importance of preoperatively diagnosing SBV, which enables early laparoscopic devolvulation without bowel resection.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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