Primary Distal Ileal Volvulus Presenting As Acute Intestinal Obstruction in an Adult: A Case Report.

Volvulus is defined as the abnormal twisting of a segment of the gastrointestinal tract around its mesenteric axis, resulting in luminal obstruction with potential compromise of the mesenteric blood supply. While colonic volvulus is common in adults, small-bowel volvulus is rare and represents a surgical emergency due to the high risk of bowel ischemia, necrosis, and sepsis. Although adult primary ileal volvulus has previously been described, isolated distal ileal volvulus without identifiable secondary pathology remains uncommon. A 52-year-old female with no comorbidities presented with a three-day history of progressively worsening abdominal pain, obstipation, and abdominal distension. Clinical examination revealed right iliac fossa tenderness with a palpable cystic swelling and features suggestive of small-bowel obstruction. Radiological evaluation demonstrated dilated small-bowel loops with air-fluid levels on plain radiography, and contrast-enhanced computed tomography revealed a transition point in the distal ileum with twisted bowel loops, consistent with ileal volvulus. Emergency exploratory laparotomy revealed a 360-degree anticlockwise volvulus of approximately 20 cm of terminal ileum with irreversible ischemic changes. Resection of the gangrenous ileal segment along with limited caecal resection was performed, followed by exteriorization as a double-barrel ileocolostomy. The patient had an uneventful recovery apart from a minor surgical site infection and subsequently underwent successful stoma reversal two months later. Histopathology confirmed transmural ischemic necrosis without evidence of malignancy or tuberculosis. Preoperative diagnosis remains difficult because clinical features are nonspecific, although contrast-enhanced CT can provide important clues when ileal volvulus is suspected. Isolated distal ileal volvulus remains an uncommon entity, and maintaining a high index of suspicion together with careful interpretation of CT findings may facilitate early diagnosis and improve outcomes.