Diagnosis Of Midgut Volvulus Research Articles

Midgut volvulus secondary to congenital malrotation in an adult with Ladd’s band: a case report

Adult midgut volvulus is a rare surgical disease, with an estimated incidence of less than 0.15%, and more common in Asia and Africa as compared to Europe and the US. It is a developmental anomaly characterized by failure to complete normal fetal rotation of the midgut around the Superior Mesenteric Artery (SMA) inside the peritoneal cavity. Though rare, adult midgut volvulus has the potential for bowel ischemia-related complications, and thus clinicians should have a reasonable index of suspicion to diagnose this. Early computed tomography (CT) scan with diagnostic accuracy of more than 83% would help in early recognition and management of these rare causes of intestinal obstruction. In this study, we reported the case of an adult primary midgut volvulus in a 30-year-old male who presented with features of acute bowel obstruction with a history of similar recurrent episodes and renal transplant. Diagnosis of midgut volvulus was made based on contrast-enhanced CT findings, and Ladd’s procedure was performed.

Intrauterine midgut volvulus as a rare cause of intestinal obstruction: a case report

BackgroundIntrauterine midgut volvulus is a very rare, life-threatening condition, and prenatal diagnosis is difficult. In this article, we present a case of midgut volvulus followed by a pre-diagnosis of antenatal jejunal atresia.Case presentationA 1-day-old Turkish male baby, who was followed with a diagnosis of antenatal jejunal atresia, with a birth weight of 3600 g, delivered by cesarean section at 38 weeks of gestation from a 19-year-old mother in her fourth pregnancy, was taken to the newborn intensive care unit. The patient underwent surgery on the postnatal first day with a preliminary diagnosis of jejunal atresia. It was observed that the small intestine was rotated two full cycles from the mesenteric root. Bowel blood circulation was good. Volvulus was untwisted. There was malrotation. Ladd's procedure was performed. The baby was discharged on the seventh postoperative day with full oral feeding. The patient is still in the first postoperative year and follow-up has been uneventful.ConclusionIntrauterine midgut volvulus has been associated with high mortality in the literature. Differential diagnosis of midgut volvulus in patients with antenatal intestinal obstruction, close prenatal follow-up, appropriate delivery and timing of surgical intervention may significantly reduce morbidity and mortality.

Diagnostic function of ultrasonography in malrotation of intestine with midgut volvulus

Objective Malrotation of intestine with midgut volvulus is a special disease in newborns.It is important of early diagnosis to avoid the risk of intestinal infarct and necrosis.We intended to explore the value of early ultrasonographic diagnosis in malrotation of intestine with midgut volvulus, comparing with upper gastrointestinal imaging. Methods Ultrasonographic features and upper gastrointestinal imaging of 48 surgically confirmed malrotation of intestine with midgut volvulus between January 2011 and December 2014 were retrospectively analyzed. Results All patients were comfirmed by operaion.The rotational degree of midgut volvulus were 90 to 720°.In 43 of 48 patients(89.58%)of malrotation of intestine with midgut volvulus were diagnosed by ultrasonography.The typical ultrasonographic features were calledwhirlpool sign, which was the superior mesenteric vein and the mesentery around the superior mesenteric artery.In 35 of 48(72.92%)patients with malrotation were confirmed by the upper gastrointestinal imaging.The typical sign of the upper gastrointestinal imaging was the helical form of the distal duodenum and proximal jejunum located at middle abdomen.Compared with upper gastrointestinal radiographic examination, ultrasonographic examination had more sensitivity in diagnosis of malrotation of intestine with midgut volvulus(P<0.05). Conclusion Ultrasonographic examination have more sensitivity in diagnosis.Noninvasiveness, absence of X-rays, and low costs could make ultrasonographic examination a useful screening test in patients with suspected malrotation of intestine with midgut volvulus.Whirlpool signcould be considered a specific ultrasonographic sign in diagnosis of midgut volvulus, which could provide reference for the clinical treatment of malrotation of intestine with midgut volvulus. Key words: Ultrasonography; Malrotation; Midgut volvulus

Isolated ileal heterotopic pancreas in a child: A clinically undetected cause of ileoileal intussusception

Introduction: Pancreatic heterotopia has been described most frequently in stomach and duodenum. Isolated occurrence of heterotopic pancreas in ileum is exceptional and is usually discovered incidentally during surgery. In rare cases, heterotopic pancreas has been reported as a lead point of ileoileal intussusception. case report: A one-year-old boy was presented with recent onset of constipation and abdominal distention. radiologic investigation suggested a diagnosis of midgut volvulus with ileoileal intussusception. resection anastomosis of the intussusception was performed. Histologic examination of the resected specimen showed heterotopic pancreas in the wall of intussusceptum at its tip. No other significant pathology was found. conclusion: Ileal heterotopic pancreas is a rare cause of intussusception at any age and is usually not evident clinically. Hence, careful examination of the lead point of intussusceptum in resection specimens is mandatory to delineate the underlying etiology of these cases.

Computed tomographic diagnosis of midgut volvulus in a 5-year-old child

Malrotation with midgut volvulus requires prompt recognition and urgent treatment. We describe a 5-year-old boy who presented with malrotation and midgut volvulus in whom the diagnosis was made by computed tomography. We describe the diagnostic images and operative findings in the patient. This case highlights the importance of recognizing the inversion in orientation of the superior mesenteric vessels and “whirlpool” sign in making the diagnosis of midgut volvulus when few other clues may be present.

Bilious vomiting in the newborn period: surgical incidence and diagnostic challenges

Aims Bilious vomiting in the newborn is a potentially life threatening emergency. Malrotation, a disorder of abnormal intestinal rotation and fixation, predisposes newborns to midgut volvulus. Plain abdominal films and upper gastrointestinal contrast studies form the mainstay of radiological diagnosis. 1) To determine the incidence of surgical pathology in newborns with bilious vomiting referred to a regional paediatric surgical centre. 2) To assess the predictive value of radiological investigations Methods A total of one hundred and fourteen infants referred for radiological assessment on the day of presentation were identified from the regional radiological database (October 2006–April 2008). Exclusion criteria included abdominal wall defects, congenital cardiac conditions, congenital anomalies and vomiting beyond the neonatal period. A total of 23 infants were excluded. All infants had plain abdominal films and upper gastrointestinal contrast studies. In addition, five infants had abdominal ultrasonography. Results 18.6% (17/91) of newborns presented with intestinal pathology, of which all 17 required surgery. Thirteen newborns (14.2%) had malrotation (seven had additional midgut volvulus), two had a duodenal web, one each had colonic pneumatosis and intussusception. Plain films and clinical examination did not suggest malrotation in the positive cases. Upper gastrointestinal contrast studies diagnosed malrotation in eleven cases, equivocal diagnosis of malrotation in two cases with midline duodenojejunal junction and a diagnosis of duodenal web in a further two cases. The predictive value of upper gastrointestinal contrast studies in diagnosing malrotation was 85%. Ultrasonography secured the diagnosis of midgut volvulus based on the “whirlpool sign”, in the two equivocal cases with midline duodenojejunal junction and this was confirmed during surgery. All thirteen cases had a Ladd9s procedure. None had ischaemic bowel. Conclusion The incidence of malrotation in our population is less than previously reported, probably because our regional policy dictates that all infants with a single bilious vomit require specialist investigation. This study confirms that clinical examination and plain abdominal films have no predictive value in diagnosing midgut volvulus. The study also confirmed that upper gastrointestinal contrast studies, in combination with ultrasound improves the predictive value in diagnosing surgical pathology.

Unusual Presentations of Midgut Volvulus With the Whirlpool Sign

The purpose of this series was to emphasize the varied presentations of midgut volvulus from neonatal life to well into adulthood and to evaluate the role of the whirlpool sign on sonography in diagnosing this condition. A retrospective search of all midgut volvulus cases diagnosed in the radiology department of a 1500-bed general hospital between February 2002 and July 2005 was done. Eight patients with surgically confirmed midgut volvulus were found, all of whom had undergone sonography as the initial screening investigation. Eight patients, with ages ranging from 9 days to 32 years (mean age, 11.8 years), had undergone sonography for varied conditions, including bilious and nonbilious vomiting, vague abdominal pain, epigastric lumps, weight loss, features mimicking appendicitis, and pancreatitis. In all patients, the diagnosis of midgut volvulus was made on the basis of the clockwise whirlpool sign on sonography. Subsequently, 4 patients underwent upper gastrointestinal series, and contrast-enhanced computed tomography was done in 6 cases. Surgical confirmation of the diagnosis was obtained in all cases. Two patients were taken for surgery on the basis of only sonographic findings. Midgut volvulus can also appear much beyond the neonatal age group with a variety of clinical presentations, making the clinical diagnosis in such patients very difficult, if not impossible. Identification of the clockwise whirlpool sign on sonography is an accurate way of diagnosing this condition, which can preclude the need for further investigations and can allow prompt surgical intervention.

Preoperative sonographic diagnosis of midgut malrotation with volvulus in adults: The “whirlpool” sign

Midgut malrotation and volvulus, found mostly in children, are rare and difficult to diagnose preoperatively in adults. We report 2 cases in which a 68-year-old man and a 75-year-old woman presented with intermittent cramping abdominal pain, abdominal distention, and vomiting. Abdominal sonography demonstrated wrapping of the superior mesenteric vein and bowel loops around the superior mesenteric artery (the “whirlpool sign”) in both patients. Abdominal CT revealed similar findings. The diagnoses of midgut volvulus and mesenteric malrotation were made, and the patients underwent laparotomy. The man was confirmed to have duodenojejunal malrotation and volvulus, and the woman had cecal volvulus. The whirlpool sign is valuable for the preoperative diagnosis of mesenteric vessel malrotation and midgut volvulus. © 1999 John Wiley & Sons, Inc. J Clin Ultrasound 27:279–283, 1999.

IMP 1212 Preoperative diagnosis of midgut volvulus in adults by color doppler. Ultrasonography: Two cases report

IMP 1212 Preoperative diagnosis of midgut volvulus in adults by color doppler. Ultrasonography: Two cases report