Midgut Volvulus

Midgut volvulus results from the improper rotation and fixation of the duodenum and colon (malrotation) resulting in a long, narrow mesenteric base. Obstruction of the superior mesenteric artery may cause ischemic necrosis of the gut, which may be fatal.
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Infants in the first month constitute the majority of the cases. Symptoms usually begin about 5 days before diagnosis. The first sign of volvulus is bilious vomiting, followed by abdominal distention and GI bleeding. Peritonitis, hypovolemia, and shock follow as the ischemia continues.

Abdominal x-ray reveals a classic double bubble caused by duodenal obstruction, but this finding is nonspecific. Pneumatosis intestinalis or distal bowel obstruction may also be apparent.

Infants with rapid deterioration and obstructed loops of bowel require immediate surgery.

If the infant is not critically ill, an UGI series with water-soluble, non-ionic, isoosmolar contrast will confirm midgut volvulus. If malrotation or volvulus (suggested by a beak, spiral or corkscrew sign) is found, an immediate laparotomy is necessary.

Thirty to sixty percent of malrotations are associated with other anomalies, described below.

Diseases and Anomalies Associated with Malrotation:

Congenital Diaphragmatic Hernia Hirschsprung’s Disease

Gastroschisis Imperforate anus

Large omphaloceles Duodenal webs

Prune Belly Syndrome Mesenteric cysts

Duodenal Atresia Cardiac anomalies

Jejunal Atresia Orthopedic anomalies

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