Midgut volvulus - transmesenteric small bowel internal hernia

Case contributed by Nasir Siddiqui


History of fallopian tube cancer and had de-bulking. Now she presents with worsening abdominal pain and distension.

Patient Data

Age: 65 years
Gender: Female

CT demonstrates a small bowel obstruction due to a midgut volvulus (note the whirlpool sign of the SMA / SMV).

Case Discussion

CT with intravenous contrast of the abdomen demonstrates swirling of the mesenteric root (whirlpool sign) with dilated loops of small bowel. The mesenteric volvulus is highly concerning for vascular compromise necessitating surgical intervention.

Differential considerations

Note that these may be radiographically indistinguishable.


Transmesenteric defect was noted on laparotomy. Appropriate bowel decompression and a surgical correction were performed.

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