Malrotation With Midgut Volvulus

Abstract

PRESENTATIONA 32-day-old girl presents with ''lime green'' vomiting once per day for 3 weeks. She was sent to the emergency department by the primary pediatrician for poor weight gain and continued vomiting. RADIOGRAPHIC FINDINGSA plain radiograph of the abdomen ( Fig. 1) demonstrates no bowel dilatation or evidence of obstruction. The stomach shadow appears mildly distended with fluid. Early images from a fluoroscopic upper gastrointestinal (GI) series show distention of the first and the second portions of the duodenum ( Fig. 2A) with a marked 13-minute delay of contrast passing into the distal duodenum and the proximal jejunum. After passage of contrast through the partial obstruction, the duodenojejunal junction is noted to be abnormally low in position and does not cross to the left of the left vertebral pedicles (Fig. 2B). FIGURE 1. Supine radiograph of the abdomen demonstrates a nonspecific bowel gas pattern with no evidence of obstruction. There may be a distended fluid filled stomach (FFS) in the left upper quadrant.

An uncommon cause of well-known symptoms: acute abdomen in a 2-year-old boy with intestinal malrotation. Case report and literature review

“…Ultrasonography of the abdomen has almost 100% sensitivity in detecting neonatal malrotation and was suggested to be a good screening tool for effectively ruling out malrotation at risk of volvulus [10]. It shows the inversion of the SMA and superior mesenteric vein (SMV), which can be also revealed in the computed tomography study [11][12][13]. Additionally, USG may show dilated bowel loops which was the only ultrasound finding present in the present case.…”

Gastrointestinal motility should be emphasized after laparotomy treatment for complete small intestinal volvulus in older adults

“…This condition, which is also known as midgut volvulus, more commonly occurs in children, where it may be caused by anatomical abnormalities of fixation and rotation of the intestines. [3] Complete small intestine volvulus is a rare entity in adults. In contrast to segmental volvulus, in which predisposing factors such as adhesive bands and diverticula are present, complete intestinal volvulus occurs in the absence of underlying abnormalities in adults.…”

Sonographic Findings of Midgut Malrotation With Volvulus: A Case of Upper Intestinal Obstruction in a Neonate

“…1 The majority of cases of midgut malrotation remain asymptomatic, with volvulus occurring most often within the first month of life. 2 Fluoroscopic upper gastrointestinal (UGI) contrast imaging is typically used to diagnose midgut malrotation by identifying the improper course of the duodenum. Although gastrointestinal sonography is not classically used to detect midgut malrotation, gray-scale and Doppler sonography can detect a reversed relationship between the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) that is commonly associated with the condition.…”