Midgut volvulus causing obstruction

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 ischemia and infarction if it is not diagnosed and treated early.

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

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