Midgut volvulus of adult
66-year old lady with acute colicky abdominal pain
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In this case the typical CT findings of malrotation with midgut volvulus can be seen. The CT whirl or whirlpool sign describes the swirling appearance of bowel and mesentery twisted around the SMA axis. Additional CT finding is the distension of several small bowel loops due to obstruction.
Midgut volvulus is a complication of malrotation in which clockwise twisting of the bowel (whirlpool sign) around the SMA axis occurs because of the narrowed mesenteric attachment. This life-threatening condition is a clear indication for emergent surgery.
The clinical diagnosis of midgut volvulus in adolescents and adults is difficult because the presentation is usually nonspecific and malrotation is rarely considered. Recurrent episodes of colicky abdominal pain with vomiting over a period of months or years are typical and may eventually lead to imaging.
- Pickhardt PJ, Bhalla S. Intestinal malrotation in adolescents and adults: spectrum of clinical and imaging features. AJR Am J Roentgenol. 2002;179 (6): 1429-35. AJR Am J Roentgenol (full text) - Pubmed citation