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Case Reports
. 2016 Jun 22;11(3):271-4.
doi: 10.1016/j.radcr.2016.05.012. eCollection 2016 Sep.

Intestinal malrotation and midgut volvulus

Hidayatullah Hamidi  1 , Yalda Obaidy  2 , Sahar Maroof  1
Affiliations
Case Reports

Intestinal malrotation and midgut volvulus

Hidayatullah Hamidi et al. Radiol Case Rep. .

Abstract

A four-day-old boy presented with persistent bilious vomiting, bloody stained stool, and mild abdominal distension. Transabdominal ultrasound demonstrated a round soft-tissue mass-like structure in the right upper quadrant. With color Doppler ultrasound, the whirlpool sign was observed. Abdominal radiograph showed nonspecific findings. Upper gastrointestinal series revealed upper gastrointestinal tract obstruction at the level of distal duodenum. The diagnosis of intestinal malrotation with midgut volvulus was established and the treated surgically. Intestinal malrotation is congenital abnormal positioning of the bowel loops within the peritoneal cavity resulting in abnormal shortening of mesenteric root that is predisposed to midgut volvulus. Neonates and infants with persistent bilious vomiting should undergo diagnostic workup and preferably ultrasound as the first step. With classic sonographic appearance of whirlpool sign, even further imaging investigations is often not needed, and the surgeon should be alerted to plan surgery.

Keywords: Intestinal malrotation; Midgut volvulus; Upper gastrointestinal obstruction.

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Figures

Fig. 1
Fig. 1
Color Doppler abdominal ultrasound with high frequency linear transducer: superior mesenteric artery (SMA) arises from abdominal aorta (AA) (B) and goes to the center of a round mass-like structure—the twisted mesentery. SMA turns around superior mesenteric vein (SMV) in a clockwise fashion (A) than follows its way toward the portal vein (C).
Fig. 2
Fig. 2
Anteroposterior abdominal radiograph: no colonic gas in right hemiabdomen (as the duodenal loops located in the right hemiabdomen). Colonic gas is seen in the left hemiabdomen.
Fig. 3
Fig. 3
Upper GI series: stomach and proximal 3 parts of duodenum are slightly distended. The DJF, however, not opacified but can be estimated that it is located lower than its normal position. No distal contrast passage.
Fig. 4
Fig. 4
Necrotic jejunal loops twisted around the mesentery.
See this image and copyright information in PMC

References

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