Tevaearai H, Achtari C, Suter M
Service de chirurgie générale, CHUV, Lausanne.
Helv Chir Acta. 1994 Dec;60(6):945-7.
As a cause of small intestine occlusion, volvulus is often a consequence of a band or adhesions. Except in infants, it is rarely the primary cause of symptomatology. Between January 1976 and December 1992, 13 patients (7 women and 6 men, mean age of 56.8 years) were admitted in our department for an acute abdomen due to a spontaneous primary volvulus of the small bowel. Clinical examination and laboratory tests did not help in preoperative diagnosis. All patients underwent an explorative laparotomy. Six patients had had prior abdominal surgery but none of them presented adhesion or band. In 8 patients (62%), detorsion was sufficient. Resection of a segment of small bowel was necessary in 4 patients. Gangrenous of the entire bowel was observed in one patient who rapidly died. Two patients presented minor complications. One patient with Down syndrome died of bronchoaspiration. One patient has been reoperated on one year later for recurrence of the volvulus, and underwent a Noble procedure. We conclude that volvulus of the small bowel is a rare cause of acute abdomen that must be remembered. Early surgery is mandatory to reduce the risk of gangrene, which is known to double the mortality. Laparoscopy will be helpful in early diagnosis and therapy.
作为小肠梗阻的一个病因，肠扭转通常是束带或粘连的结果。除婴儿外，它很少是症状学的主要原因。1976年1月至1992年12月期间，13例患者（7名女性和6名男性，平均年龄56.8岁）因小肠自发性原发性肠扭转导致急腹症入住我科。临床检查和实验室检查对术前诊断没有帮助。所有患者均接受了剖腹探查术。6例患者曾接受过腹部手术，但均未出现粘连或束带。8例患者（62%）扭转复位充分。4例患者需要切除一段小肠。1例患者观察到全肠坏疽，很快死亡。2例患者出现轻微并发症。1例唐氏综合征患者死于支气管误吸。1例患者1年后因肠扭转复发再次手术，并接受了诺布尔手术。我们得出结论，小肠扭转是急腹症的罕见病因，必须牢记。早期手术是必要的，以降低坏疽风险，已知坏疽会使死亡率加倍。腹腔镜检查将有助于早期诊断和治疗。
