Computed tomography in the diagnosis of adult midgut rotational anomalies: A report of two cases

Abstract

Adult midgut rotational anomalies are difficult to diagnose. Any symptoms present in adults may be the result of intermittent volvulus of the midgut. Successful outcome of this clinical condition depends on prompt diagnosis and timely surgical intervention. Computed tomography (CT) is useful in early identification of these lesions in the abdomen. However, the specific CT signs, the "superior mesenteric vein rotation" sign and the "whirl" sign, are easy to overlook if not kept in mind, as occurred in one of our two patients. In the other patient, CT played the major role in preoperative diagnosis.

Laparoscopic Management of Intestinal Malrotation With Cocoon Deformity: A Case Report

“…BE has been used to identify the position of the cecum and may reveal a beak-like stenosis of the intestine in patients with midgut volvulus. 11 Malrotation can also be diagnosed on computed tomography (CT) with the presence of a right-sided small bowel, a left-sided cecum, and an inverse relationship between the superior mesenteric artery (SMA) and the superior mensenteric vein (SMV) wherein SMV is visualized to the left of, instead of the right of, SMA. 12 A distinctive whirlpool sign, the consequence of the twisting of the small bowel and mesentery around the narrowed SMA pedicle, may be seen on CT imaging of a patient with midgut volvulus.…”

Late Presentation of Intestinal Malrotation: An Argument for Elective Repair

“…A review of the embryology is fundamental to the understanding of malrotation. Articles by Wang and Welch, Devlin et al, Wang and Yeh, and Ladd describe the process well and divide intestinal rotation and subsequent anomalies into three stages [2][3][4][5]. Briefly, midgut rotation begins during the fifth week of gestation.…”

“…The typical findings of malrotation are shown in Figure 2A and 2B. Malrotation can be diagnosed by ultrasound, UGI studies, barium enema, CT scan, magnetic resonance imaging (MRI), arteriography, and even plain films [4, 7]. Ultrasonography may reveal malposition of the superior mesenteric artery (SMA) and vein (SMV) and that finding leads the radiologist to suspect malrotation.…”

Surgical management of intestinal malrotation in adults

“…The BE may show malposition of the right colon and cecum and may reveal a beaklike stenosis of the intestine in patients with midgut volvulus (Fig. 7) [ 15]. A normal UGI does not exclude the possibility of malrotation; abnormalities of rotation of the cecocolic loop may occur in the face of normal rotation of the duodenojejunal loop.…”