Presentation
Bilious vomiting 4-5 episodes per day following each feed since day 3 of life. Abdominal distention since day 3. Patient is passing stools. Born at full term. No post delivery complications. Antenatal scan normal.
Patient Data
Grey scale and color Doppler ultrasound reveals clockwise rotation of the midgut (jejunum) giving a whirlpool sign. The relation between the SMA and SMV has been reversed. The bowel showed normal vascularity.
The stomach and duodenum appears distended and fluid-filled suggestive of incomplete obstruction. The distal ileal loops are collapsed.
Case Discussion
The whirlpool sign is a sonographic finding caused by twisting of bowel and mesenteric vessel branches. This creates an image of swirling strands with soft tissue attenuation with background attenuation in fat, giving the appearance of a hurricane on a weather map 1. The abrupt termination of dilated duodenum in the swirl region is highly suggestive of volvulus 1.
Midgut volvulus is the most common site for intestinal volvulus, accounting for 10% of intestinal and 11% of strangulating obstructions 2, occurring early in life or in adults 3. Midgut volvulus is usually associated with malrotation of gut.