Midgut volvulus with a mesenteric cyst

Case contributed by Dr Maulik S Patel

Presentation

Abdominal pain with vomiting - 1 day.

Patient Data

Age: 3 yrs
Gender: Male
Ultrasound

There is whirling of superior mesenteric vein around superior mesenteric artery in upper abdomen, from crainal to caudal aspect.  There is associated whirling of small bowel loops; leading to complete small bowel obstruction. There are few fluid filled small bowel in upper abdomen with maximum diameter upto 24 mm. These dilated loops show mild hyperperistalsis. Small bowel loops distal to obstruction are collapsed.

Cecum is seen in right upper mid abdomen; lateral to inferior vena cava.

There is large encysted fluid with echoes anterior to small bowel, on both sides of abdomen. Whirling of small bowel causes anterior lobulation in this collection. Approximate size - 12 x 12 x 7 centimeter.

There is minimal anechoic fluid in pelvis.

Case Discussion

Findings suggest midgut volvulus along with a large mesenteric cyst and small bowel obstruction. Surgery was done within few hours which confirmed findings. 

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