The patient underwent an exploratory laparotomy

The patient underwent an exploratory laparotomy, and we found that the mesenteric root of the small bowel was twisted 720 degrees (two circles) in clockwise rotation but there was no further ischemic change of the intestinal wall (Fig. 2). No organic lesion was found in the whole bowels. Therefore, the volvus was reduced without intestinal resection. The patient began to have bowel movement on the fifth postoperative day (POD) and then to take a soft diet. She was discharged on POD 9. There was no surgical complication and the patient made a full recovery. She had no postoperative abdominal symptoms during the 3 years’ follow-up.
Discussion The incidence of the primary type of SBV in the West is from 10% to 22% whereas it melanin inhibitor varies from 31% to 100% in parts of Africa and the Middle East. The possible factors may be a single large meal after absence of food during the day, or abnormally long mesenteries with short mesenteric attachments. The most common symptom of SBV is sudden abdominal pain, and bowel resection is necessary for 53.5% of SOS response patients. Only 12.4% of patients can receive simple devolvulation. At present, CT is the superior diagnostic tool providing 83.3% accuracy whereas the accuracy is 6.2% for plain films and 12.5% for ultrasonography. To the best of our knowledge, the first CT finding of primary SBV was reported by Diego et al in 1986. They only described closed loop obstruction of the mesentery in CT and no typical whirlpool sign was seen in small bowel malrotation or colon volvulus. We have also found a patient with findings similar to those described by Diego et al. The present case showed the most typical whirlpool sign we have ever seen. Peritoneal signs, a palpable mass, fever and leukocytosis are always indicators of gangrenous bowel. A compromise of venous return occurs earlier than impaired arterial supply. Overall mortality ranged from 9% to 38%. Early diagnosis, making use of improved diagnostic methods, and timely surgical intervention are important, especially if intestinal resection is to be avoided.