EC Clinical and Medical Case Reports

Primary isolated ileal volvulus is an exceptionally rare cause of mechanical small bowel obstruction (SBO) in adults, particularly in patients without prior abdominal surgery or other predisposing conditions. Delayed diagnosis may result in bowel ischemia and increased morbidity. Contrast-enhanced computed tomography (CT) plays a pivotal role in establishing an early diagnosis and assessing bowel viability. A 60-year-old man with no history of abdominal surgery presented with diffuse abdominal pain, progressive abdominal distension, and obstipation for five days. Contrast-enhanced CT demonstrated marked proximal small bowel dilatation, an abrupt transition point at the terminal ileum, the characteristic whirlpool sign of twisted mesenteric vessels, and segmental pneumatosis intestinalis. Emergency exploratory laparotomy confirmed isolated clockwise volvulus involving a 30-cm segment of the terminal ileum without bowel ischemia or necrosis. Simple detorsion restored normal bowel perfusion, eliminating the need for bowel resection. The postoperative course was uneventful. This case highlights the crucial role of contrast-enhanced CT in the early diagnosis of isolated ileal volvulus and demonstrates that pneumatosis intestinalis should not be regarded as an isolated marker of irreversible bowel ischemia. Careful correlation of imaging findings with the clinical presentation, laboratory results, and intraoperative assessment may permit bowel-preserving surgery in selected patients.

Keywords: Isolated Ileal Volvulus; Mechanical Small Bowel Obstruction; Computed Tomography; Whirlpool Sign; Pneumatosis Intestinalis; Bowel Viability

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