of the small

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Primary Segmental Volvulus of the Small Bowel - Report of 2 Cases-

Myung Duk Lee, M.D.

Pediat~ic Surgery, Department of Surgery, Kangnam St. Mary's Hospital, Catholic University Medical College, Seoul, Korea

Primary segmental

volvulus

of the small

intestine

is not associated with malrotation, malfixation of

the

midgut, nor other primary small bowel lesions such as small bowel tumors. This entity

is

known to be more prevalent in adult and in certain global areas associated

with

particular diet habits. There have been very few reports

in

neonates, but not in this country so far. The author reports two cases of primary segmental

volvulus.

Case 1 was a septic 4-day- old girl with hematochezia due to jejunal

volvulus with

partial necrosis and panperitonitis. Resection of the segment and Bishop-Koop enterostomy were suc- cessful. Case 2

was

a 3-day- old boy, who had ileal

volvulus

with ultra-short length of ileal atresia, probably due

to

intrauterine segmental volvulus. Limited resection of the atresia and spreading of the mesenteric base were enough to re- covery. The rarity of the pathognomonic findings and

limitation

of the diagnostic workup due to rapid prqgression limit early diagnosis and good survival rate in this particular condition.

.

Index Words:Volvulus, Small intestine, Primary, Segmental, Neonates

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Fig. 1. Upper gastrointestinal series of Case 1 shows abrupt interruption of dye passage at proxi- mal jejunum, but gaseous distention in the other loops indicates partial obstruction.

Fig. 2. Operative finding after detorsion of the volvulus. The involved segment reveals multiple necrotic areas and inflammatory reactions which were expanded to the other loops(Case 1).

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Fig. 3. Simple abdominal radiograph of Case 2 shows' midsmall bowel obstruction. The arrow indi- cates a circum linear gas line suggesting a ques- tionable intramural gas.

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Fig. 5. Detorsion of the volvulus segment exposes the atresia(arrow) of the ileum, narrow mesenter- ic base near the atretic point ( open arrow) and similar diameters of the loops on both sides of atresia.

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