Midgut volvulus causing obstruction

Case contributed by Dr Jeremy Jones

Presentation

Previous laparotomy for gynaecological surgery. Acute history of abdominal pain, distension and vomiting over 24 hours. Symptoms worsening.

Patient Data

Age: 60
Gender: Female

Small bowel obstruction, with locules of dependant gas in several loops, but no evidence of intestinal ischaemia or perforation.

Swirling vessels in the mesenteric root with superior mesenteric artery (SMA) and superior mesenteric vein (SMV) rotating around each other.

Annotated image

Same CT stack with annotation of the swirling vessels at the mesenteric root:

  • red: aorta and SVA
  • blue: SMV

Case Discussion

There are many causes of small bowel obstruction. In this case, the swirling vessels at the mesenteric root points to midgut volvulus as the cause of obstruction. 

The majority of midgut volvulus occurs in children because of a congenital abnormality that means the DJ flexure is not in the correct location, resulting in a short mesenteric root and predisposing to volvulus.

Any bowel that is on a mesentery can potentially undergo volvulus causing obstruction. Blood vessels in the mesentery may be compromised if the mesentery twists on itself leading to ischaemia and infarction if it is not diagnosed and treated early.

There are no features of small bowel ischaemia in this case, although there are many examples of bowel that looks normal on CT being ischaemic when explored at laparotomy.

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Case information

rID: 34033
Case created: 2nd Feb 2015
Last edited: 8th Nov 2017
Inclusion in quiz mode: Included

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