Presentation
Abdominal pain, bloating , nausea and vomiting for 4 months.
Patient Data
Grossly distended stomach filled with food residue and associated delayed gastric emptying. Gastro-esophageal reflux to distal esophagus noted. The delayed film demonstrates small bowel loops within the right paracolic gutter. The film shows the absence of the normal duodenal C loop, D3 not crossing the midline and duodenojejunal junction not at the same height as the duodenal bulb. No corkscrew appearance of proximal small bowel loops to indicate midgut volvulus. The film classically demonstrates midgut malrotation.
Significantly distended stomach containing fluid and food residue. Abnormal position of the retromesenteric duodenum with small bowel loops located within the right paracolic gutter, cecum in the pelvis and ascending colon within the left hemiabdomen. In addition, there is a reversal of the SMA/SMV position is evident. Incidental fetal lobulation of both kidneys and left extrarenal pelvis. No features of basal aspiration pneumonitis.
Case Discussion
The case demonstrates the classic features of midgut volvulus in an adult patient. Normally the presentation occurs early in the neonatal period and childhood. Midgut volvulus is a congenitally-acquired pathology due to failure of normal intestinal rotation during embryologic development.
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