Malrotation with midgut volvulus

Case contributed by Dr Gianni Giancaspro

Presentation

The patient presented to the emergency room with bilious vomiting.

Patient Data

Age: 19 days
Gender: Female
X-ray

A cluster of dilated small bowel loops is noted in the left hemiabdomen along with air-fluid levels seen on the lateral decubitus view, suggestive of an obstructive process. In this age group, malrotation with midgut volvulus is one of the differential possibilities.

Fluoroscopy

Frontal and lateral projections from an upper GI study demonstrate abnormal bowel configuration. 

On the frontal view, the duodenum is noted to not cross the midline, and the duodenojejunal junction is inferior to the level of the pylorus.  

On the lateral view, a "corkscrew" appearance of the proximal small bowel is demonstrated, suggestive of volvulus. 

Altogether the findings are in keeping with malrotation with midgut volvulus. 

Case Discussion

The imaging findings were confirmed intraoperatively by the pediatric general surgery team.  

 

Case provided by Dr. Christine Saint-Martin and reviewed by Dr. Karl Muchantef.

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Case information

rID: 77419
Published: 25th May 2020
Last edited: 26th May 2020
Inclusion in quiz mode: Included
Institution: McGill University