Vascular compromise in chronic volvulus with midgut malrotation

Abstract

Three cases of chronic volvulus of the small bowel in midgut malrotation are presented, all of whom manifested similar angiographic findings: proximal occlusion of the superior mesenteric artery and vein and development of collateral vessels. These findings may indicate the pathophysiology of chronic volvulus in midgut malrotation; the volvulus is progressive and eventually results in the twisting of the mesenteric root itself, but because of its chronic nature collateral circulation develops, eliminating bowel necrosis. Computed tomography (CT), performed in two cases, revealed dilated, tortuous vessels in the mesentery in addition to the known CT finding of a whirl-like pattern of the volvulated small bowel loops. Sonography, performed in one case, showed an unique feature of whirling sonolucent layers probably representing the volvulated small bowel loops intermixed with dilated mesenteric collateral vessels. We would like to emphasize the usefulness of CT and sonography in the early diagnosis of those cases with vague and nonspecific clinical manifestations.

Sonographic evaluation of superior mesenteric vascular relationship in malrotation

“…He postulates that this represents failure of counter clockwise travel of the SMV around the SMA which should have occurred during normal embryologic bowel rotation [12]. Mori and his coauthors later confirmed the CT finding of an abnormal SMA/SMV relationship [13].…”

“…More recently, sonographic description of a midline abdominal mass with whirling sonolucent layers was thought to represent the volvulized bowel loops with dilated mesenteric collateral vessels [13].…”

Ischemic hepatitis induced by mesenteric volvulus in a patient with chronic obstructive lung disease

“…There are some reports of its effect on arterial blood flow during emergency surgery, demonstrated by angiographic images. [10][11][12] However, to our knowledge, there have been no reports of abnormal findings on venography or portography. When the mesentery is twisted severely enough to reduce mesenteric venous return, this can result in acute hypoperfusion of the portal vein.…”

Multislice computed tomography angiography findings of chronic small bowel volvulus with jejunal diverticulosis

“…In another report, 9 the authors proposed that small bowel diverticula were an independent risk factor for small bowel volvulus. In addition, Mori et al 10 discussed the concept that volvulus may be chronic and lead to vascular compromise. Although the diverticulum can be evaluated in the portal venous phase, it is easy to recognize the SMA, the location of the small bowel volvulus, and the diverticulum on MSCTA reformatted images.…”