Primary Small Intestinal Volvulus in a 91-Year-Old Patient: A Rare Case of Successful Laparotomy With Resection and Anastomosis.

Primary small intestinal volvulus (PSIV) is a rare cause of acute bowel obstruction in adults and is exceptionally uncommon in the very elderly. It occurs when the small intestine twists around its mesenteric axis without an identifiable secondary cause, such as adhesions or hernias. This case report describes a 91-year-old woman who presented with abdominal pain and minimal rectal bleeding, posing a diagnostic challenge in the context of multiple comorbidities and atypical symptoms. CT imaging demonstrated a persistent "whirlpool sign," raising suspicion for volvulus, and the patient underwent emergency laparotomy with detorsion and resection of nonviable segments. Despite advanced age and high perioperative risk, the patient achieved a favorable postoperative outcome following timely surgical intervention. This case highlights the diagnostic difficulty of PSIV in the very elderly population and underscores the importance of early operative management to prevent progression to bowel ischemia and reduce morbidity and mortality.