Planned Relook Laparotomy for the Salvage of Extensive Small Bowel Ischemia in Primary Volvulus: A Case Report From a Resource-Limited Setting.

Extensive small bowel ischemia due to volvulus poses a major surgical challenge: premature resection risks short bowel syndrome, while delayed intervention can lead to necrosis and sepsis. We report the successful salvage of extensive small bowel ischemia using a staged surgical approach with planned relook laparotomy in a 34-year-old woman who presented with recurrent small bowel obstruction. Intraoperatively, a 360° volvulus extending from 10 cm distal to the ligament of Treitz to 2 cm proximal to the ileocecal valve was identified, with diffuse ischemia. After derotation and warm saline application, partial reperfusion was observed, and immediate resection was deferred. A planned relook laparotomy 48 hours later revealed complete recovery of bowel viability. Despite the favorable surgical outcome, the patient succumbed on postoperative day 26 to hospital-acquired pneumonia, unrelated to the primary surgical pathology. This case underscores the importance of individualized intraoperative decision-making and supports planned relook laparotomy as a safe strategy to restore marginally ischemic bowel and prevent unnecessary resection, particularly in resource-limited settings.