Midgut volvulus

Case contributed by Dr Jeremy Jones

Presentation

Bilious vomiting in a neonate.

Patient Data

Age: 6 weeks
Gender: Male
Barium

Contrast demonstrates a malplaced DJ flexure and a corkscrew appearance of the jejunum.  This confirms both malrotation and volvulus.

Case Discussion

Contrast has been administered via a nasogastric tube to a child who presents with acute onset of bilious vomiting and abdominal pain.

It passes from the stomach into the duodenum. 

The DJ flexure should usually be located to the left of midline at the level of the duodenal cap. Here it is not, indicating that there is malrotation.

The lumen is narrowed and passes directly inferiorly in a corkscrew pattern. Findings are of midgut volvulus secondary to intestinal malrotation.

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