Case report: small bowel volvulus following laparoscopic-assisted Soave pull-through for adult Hirschsprung disease: a diagnostic dilemma.

Introduction and Importance: Small bowel volvulus (SBV) is the twisting of a small bowel loop around its mesentery, leading to closed-loop intestinal obstruction. SBV following laparoscopic procedures is a rare complication. Patients often present with non-specific symptoms, creating a diagnostic dilemma and delaying surgical intervention. A high index of suspicion and timely imaging are essential. Understanding the mechanisms, risk factors, clinical presentation, and management is paramount. Case Presentation: A 21-year-old woman with a confirmed diagnosis of adult Hirschsprung disease underwent laparoscopic-assisted Soave pull-through with protective loop ileostomy. On the 2nd postoperative day, she developed signs and symptoms of small bowel obstruction (SBO). Exploratory laparotomy revealed a 720° SBV proximal to the ileostomy with areas of patchy ischemia. Derotation was performed, and the patient was discharged in stable condition after 5 days. She is currently recovering smoothly and awaiting ileostomy reversal. Clinical Discussion: SBV is an uncommon but serious complication following laparoscopic surgery. Mechanisms remain unclear, though pneumoperitoneum, adhesions, and bowel mobility are implicated. Presentations are non-specific, requiring vigilance and early imaging to ensure prompt diagnosis and intervention. Conclusion: Post-laparoscopic SBV is rare but potentially life-threatening. Timely recognition, diagnosis, and surgical management are essential to prevent morbidity and mortality.