Volvulus midgut

Types of Enema Therapies 43 Appendicitis 46 Appendicitis Imaging 47 Small Bowel Obstruction 56 Midgut Volvulus 58 Meckel s Diverticulum 59 Enteritis 60... 

The main causes for a double bubble are duodenal atresia, annular pancreas, and midgut volvulus. Less frequently it may be secondary to duodenal web, Ladd s band, or preduodenal portal vein (Crowe and Sumner 1978). 

Midgut volvulus is the most dramatic consequence of intestinal malrotation. When present at birth, the classic finding on a plain film is partial obstruction of the duodenum, but evidence of complete obstruction may also be present. In such cases, it is impossible to distinguish midgut volvulus from... 

Partial duodenal obstruction may be produced by duodenal stenosis, duodenal web, Ladd s bands, midgut volvulus, annular pancreas, preduodenal portal vein, and duplication cyst. Plain radiographs show gaseous distension of the stomach and duodenum with a normal or diminished quantity of air in the small bowel. Content studies may be necessary to differentiate between midgut volvulus and partial duodenal obstruction caused by a web or stenosis (Auringer and Sumner 1994). Sonography is helpful to rule out extraluminal causes such as a duplication cyst. 

Malrotation is a general term that includes a wide spectrum of anomalies that occur when intestinal rotation and fixation happens in an abnormal way. Failure of completion of the normal intestinal rotation leads to a continuum of anatomic abnormalities with a common clinical denominator consisting of obstruction with the potential for midgut volvulus. Only its presentation as an abdominal emergency in the neonatal period is discussed here. 

Fig. 1.6a,b. Midgut volvulus. A 5-day-old neonate with severe vomiting, a Abdominal plain radiograph shows marked distension ofthe stomach and duodenal bulb and absence of air more distally. b Surgery demonstrated midgut volvulus with necrosis of the entire midgut... 

Fig. 1. 7. Schematic drawing that shows midgut volvulus (C) developing from non-rotation (A) or incomplete rotation (B). The lack of normal fixation due to short mesentery permits the bowel to volvulize...

Volvulus of the midgut may occur at any age but it is more common in the first month of life, most of them presenting in the first week of life (Torres and Ziegler 1993). In general, the symptoms are those of obstruction. The child with obstruction secondary to midgut volvulus typically presents with a sudden onset of bilious vomiting often preceded... 

Fig. 1.8a,b. Midgut volvulus. Supine (a) and lateral (b) radiographs show distension of the stomach and duodenum with some distal intestinal air in a 12-day-old infant with severe vomiting... 

Fig. 1.11a,b. Midgut volvulus in a 7-day-old girl with bilious vomiting. Upper gastrointestinal series. Anteroposterior (a) and lateral projections (b). The distal duodenum courses anteriorly and tapers to a beaked obstruction (arrow). No contrast is observed beyond the obstruction, but there is distal air indicating a recent complete obstruction... 

Ultrasound may also be a useful tool in the early detection of midgut volvulus because of its availabil-... 

The characteristic finding of midgut volvulus in the US examination is the whirlpool sign produced by the twisting of the bowel, mesentery, and superior mesenteric vein around the axis of the superior mesenteric artery (Fig. 1.13). The whirlpool sign, proposed by Pracros et al. (1992), directly indicates the anatomic alteration caused by midgut volvulus. The SM V and tributaries wrap around the SMA as a result of the volvulus, resulting in a partial or com-... 

Besides perforated appendicitis and intussusception, the most common causes of small howel obstruction are incarcerated hernias and adhesions. Other causes of small bowel obstruction comprise a miscellaneous group of rare conditions, such as midgut volvulus, Meckel s diverticulum, advanced stages of Crohn s disease, and bezoars. Adhesions usually result from prior surgery and are often multiple. There is an increasing tendency for initial conservative management rather than immediate operative intervention, as a proportion of cases will resolve spontaneously. 

Bernstein SM, Russ PD (1998). Midgut volvulus a rare cause of acute abdomen in an adult patient. AJR Am J Roentgenol 171 639-641... 

Kassner EG, Kottmeier PK (1975) Absence and retention of small bowel gas in infants with midgut volvulus mechanisms and significance. Pediatr Radiol 4 28-30 Katz M, Phelan E, Carlin JB et al (1993) Gas enema for the reduction of intussusception relationship between clinical signs and symptoms and outcome. AJR Am J Roentgenol 160 363-366... 

Patino MO, Munden MM (2004) Utility of the sonographic whirlpool sign in diagnosing midgut volvulus in patients with atypical clinical presentations. J Ultrasound Med... 

Pracros JP, Sann L, Genin G et al (1992) Ultrasound diagnosis of midgut volvulus the whirlpool sign. Pediatr Radiol 22 18-20... 

Smet MH, Marchal G, Ceulemans R et al (1991) The solitary hyperdynamic pulsating superior mesenteric artery an additional dynamic sonographic feature of midgut volvulus. Pediatr Radiol 21 156-157 Smink DS, Finkelstein JA, Kleinman K et al (2004) The effect of hospital volume of pediatric appendectomies on the misdiagnosis of appendicitis in children. Pediatrics 113 (1 Pt l) 18-23... 

Swischuk LE, Stansberry SD (1991) Ultrasonographic detection of free peritoneal fluid in uncomplicated intussusception. Pediatr Radiol 21 350-351 Sze RW, Guillerman RP, Krauter D et al (2002) A possible new ancillary sign for diagnosing midgut volvulus the truncated superior mesenteric artery. J Ultrasound Med 21 477-480... 

Some of the pathologies of the small intestine are discussed in Chapter 1. In the current chapter, therefore, little or no attention will be paid to (midgut volvulus) malrotation, the atresias, meconium ileus, meconium peritonitis, duplication cysts, necrotizing enterocolitis (NEC) and intussusception. 

Leonidas JC, Magid N, Soberman N, Glass TS (1991) Midgut volvulus in infants diagnosis with US. Work in progress. Radiology 179 491-493... 

Midgut volvulus usually occurs in neonates and young children and is due to an abnormal rotation or fixation of both the duodenum and colon, resulting in narrowing of the mesenteric base with potential for mid-gut volvulus (Long et al. 1996). In adults, congenital anomalies of intestinal rotation are usually incidental findings. Any symptoms... 

Bergin D, Ennis R et al (2001) The dependent viscera sign in CT diagnosis of blunt traumatic diaphragmatic rupture. AJR Am J Roentgenol 177 1137-1140 Bernstein SM, Russ PD (1998) Midgut volvulus a rare cause of acute abdomen in an adult patient. AJR Am J Roentgenol 171 639-641... 

---