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.