Midgut volvulus

Clinical:

  • A 13 years old male
  • No known medical illness
  • Presented with right sided abdominal pain for 2 days and vomiting.┬áNo fever, no diarrhoea
  • Hemodynamically stable
  • No abdominal distension
  • Clinically no mass palpable, mild tenderness at right lumbar region.
  • Abdominal radiograph is unremarkable.
Contrast-enhanced CT abdomen in soft tissue window

CT scan findings:

  • The duodenum and proximal jejunum forms 2 loops, initially towards the right side before coursing to the left abdomen (yellow arrows)
  • Thickening of bowel wall, involving the third part of duodenum extending to the proximal jejunum (white arrows)
  • Mass effect with compression of IVC causing short segment narrowing of the vessel (red arrows)
  • No dilated bowel loops. No extraluminal or intramural air. No ascites.
  • SMA well opacified and normal in appearance. No SMA-SMV reversal seen
  • Appendix, caecal pole are normal (images not shown)

Diagnosis: Midgut volvolus

Discussion:

  • Potentially can occur at any age but approximately 75% of cases occur within a month of birth, 90% within a year
  • Plain radiograph: non-contributory (ranges from normal to bowel obstruction to pneumoperitoneum)
  • Upper GI study: corkscrew sign, tapering or beaking of bowel in compete obstruction, malrotation
  • Ultrasound: clockwise whirlpool sign, abnormal superior mesenteric vessels, abnormal bowel loops, free fluid
  • CT scan: whirlpool sign of twisted mesentery, malrotated configuration, inverted SMA and SMV relationship, bowel obstruction, free fluid or free gas
  • Treatment: urgent surgical repair (Ladd procedure) to prevent ischaemia

 

Author: radhianahassan