Cause and Management

small bowel volvulus is a clinical condition in which there is a torsion of all or a large segment of the small bowel mesentery in the absence of congenital malrotation or bands or postoperative adhesions. This entity occurs only rarely among the populace of the United States and Europe, but is one of the more common surgical problems encountered among patients in certain African, Asian, and Middle Eastern nations. The etiologic mech¬ anisms that favor the development of primary small bowel volvulus have not been fully defined. Although numerous possibilities have been observed and reported, a few common factors consistently emerge. Virtually all of the documentation demonstrates that the patients with this condition have an exceptionally long small bowel mesen¬ tery and a dietary practice of consuming a coarse, highfiber vegetable diet. The mortality associated with primary small bowel volvulus has been reported to range between 10% and 67%.'-2 The purpose of this report is to present the results of an experience that emphasizes important aspects of two key issues: cause and survival. The striking increase in the frequency of primary small bowel volvulus during periods in which the entire population of the region eats only one large meal a day provides the most definite correlation yet available of the etiologic role of diet. Through the strict application of current principles of fluid and electrolyte