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October 3, 1977

A New Twist

JAMA. 1977;238(14):1545. doi:10.1001/jama.1977.03280150115048

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That medical research need not always originate in the laboratory is smartly illustrated by a recent article in the Archives of Surgery (112:685-688, 1977), where Duke and Yar report on "Primary Small Bowel Volvulus." Small bowel volvulus—torsion of the bowel on its mesentery—ordinarily results from congenital anomalies or postoperative adhesions. In the absence of these predisposing factors, primary volvulus is seldom encountered by Western surgeons.

Likewise, the disorder is rarely encountered in Afghanistan. Rarely, that is, except for the holy month of Ramadan, when Mohammedans abstain from oral intake during daylight hours. Then, when darkness falls, the faithful take a large single meal. During that month, the incidence of primary small bowel volvulus rose more than tenfold; from less than one case per month (seven in 11 months) to nine or ten cases per month (in 1971 and 1970, respectively).

Intriguing here is that volvulus occurred in males only; 25