CT angiographic demonstration of a mesenteric vessel "whirlpool" in intestinal malrotation and midgut volvulus: a case report

Abstract

Although the color Doppler ultrasonography diagnosis of intestinal malrotation with midgut volvulus, based on the typical "whirlpool" appearance of the mesenteric vascular structures is well-defined in the peer-reviewed literature, the combination of both the angiographic illustration of these findings and the contemporary state-of-the-art imaging techniques is lacking. We report the digital subtraction angiography and multidetector computed tomography angiography findings of a 37-year-old male with intestinal malrotation.

Fig. 1

Intestinal malrotation and midgut volvulus. A-F. Oblique digital subtraction angiogram (A) of patient depicting "barber's pole" sign (arrows) due to rotations of superior mesenteric artery and its branches. Axial CT (B, C) and 3D-MDCT angiography (D, E) images in arterial phase (B, D) and venous phase(C, E) depicting rotational abnormality of mesenteric arterial root and its branches (arrowheads, whirl sign) along with tortuous dilated superior mesenteric vein (arrows) which also contributes to "whirlpool" configuration. Note "clockwise" rotation (superior to inferior), as viewed from caudal aspect, of both arterial branches and mesenteric vein (at least partially on each other). Image from upper gastrointestinal series with barium (F), immediately after CT-angiography examination demonstrating "corkscrew" configuration (arrows) of proximal small bowel as it twists around superior mesenteric artery. Note that excreted renal pelvocalyceal contrast remaining from CT examination complicates this image.