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Intestinal malrotation (nonrotation) with whirlpool sign

Case contributed by Keshaw Kumar
Diagnosis certain

Presentation

Intermittent abdominal pain

Patient Data

Age: 5 years
Gender: Male

There is inverse relationship between superior mesenteric artery and superior mesenteric vein. Most of the small bowel loops seen on right side of abdomen and most of large bowel loops seen on left side, --suggestive of intestinal malrotation(non rotation).

The mesentery with its proximal small bowel loops starts to whirl around the superior mesenteric vessels , giving the whirlpool sign. The positive oral contrast is seen in the distal small bowel. Bowel wall enhancement appears normal. No evidence of bowel obstruction seen.

Multiple small subcentrimeter sized discrete enhancing lymph nodes in the mesentery, likely Reactive.

Rest of the abdominal organs are unremarkable.

Case Discussion

Ladd procedure was done for this patient. Intraoperative finding was ileo-cecal junction in the left upper quadrant with most of the small bowel loops seen on right side and large bowel loops on left side of abdomen. The whirlpool sign in case of intestinal malrotation/nonrotation may be seen in midgut volvulus or intestinal nonrotation. In this case since there is no evidence of bowel obstruction, whirlpool sign is likely due to nonrotation.

Intestinal nonrotation is sometime thought to be a subtype of intestinal malrotation.

Co-author: Dr Sanjoy kumar, Director of GI surgery at Medanta hospital,Patna,India.

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