Primary small bowel volvulus in rural Nepal.

Primary small bowel volvulus is the commonest cause of intestinal obstruction in the Gorkha district of Nepal resulting in laparotomy. Yet, this problem is mentioned only briefly, if at all, in many standard textbooks of surgery. This paper presents details of the presentation, clinical findings, and surgical management of 18 cases of primary small bowel volvulus. Small bowel volvulus occurred in adults only, with an overwhelming male predominance and a low mortality despite late presentation in the majority of cases. Attention is drawn to the common finding of localized ischaemia of several centimetres of terminal ileum.