Presentation
Acute onset bilious green vomiting and distress. Soft, non-distended abdomen.
Patient Data
Contrast is injected into the stomach via the NG tube. It starts to pass into the proximal duodenum, but fails to progress into the distal duodenum. Towards the end of the study, despite waiting, contrast fails to pass to the left of the spine. At the end of the study, contrast can be seen to the right of spine.
The ultrasound confirms that there is swirling of bowel and mesentery with vessels highlighted with Doppler. Features here are of volvulus.
Case Discussion
Malrotation describes the position of small bowel mesentery. Malrotation predisposes to volvulus which is the cause of the acute presentation with bilious vomiting.
While some cases will display the classic corkscrew of volvulus on the upper GI contrast study, many will not. In these circumstances, performing an ultrasound may demonstrate the volved mesentery, bowel and vessels - especially when Doppler is employed. In this case, it clearly demonstrated to the surgical team that the bowel was volved and they needed to take the patient to theater.
In this case, there was no bowel necrosis and the bowel was de-volved and a Ladd's procedure performed.