Primary midgut volvulus in the adult: two case reports.

Primary midgut volvulus is associated with a high mortality rate. The presentation and management of two patients with primary midgut volvulus are reviewed. Both presented with severe abdominal pain inconsistent with clinical findings. Diagnosis was made intraoperatively in one case and at autopsy in the other. Surgeons need to suspect primary midgut volvulus when they encounter patients with atypical presentation of small bowel obstructions, i.e., when the severity of symptoms is inconsistent with physical findings. Primary midgut volvulus should be considered in the differential diagnosis in these patients, and, if suspected, emergent abdominal exploration is indicated.