midgut volvulus ct
The advantages and limitations of plain films barium enema studies and gastrointestinal studies were reviewed in 77 patients with malrotation. CT scanning is considered the imaging modality of choice as it can show the pathognomonic whirlpool sign of midgut volvulus.
Radiology Signs
Abstract Midgut malrotation is a surgical emergency usually seen in the first weeks of life.
. Case Discussion CT with intravenous contrast of the abdomen demonstrates swirling of the mesenteric root whirlpool sign with dilated loops of small bowel. Publication types Case Reports MeSH terms Abdomen Acute diagnostic imaging Abdomen Acute etiology Adult Angiography Diagnosis Differential Duodenal Obstruction diagnostic imaging. In adults midgut volvulus can occur as a result of undiagnosed midgut malrotation.
It is a rare cause of mesenteric ischemia in young adults92 X-ray findings are nonspecific but can include a birds beak appearance because of rotation of the bowel around the point of volvulus. Computed tomographic diagnosis of volvulus in intestinal malrotation. Utility of the CT Scan in Diagnosing Midgut Volvulus in Patients with Chronic Abdominal Pain Case Rep Surg.
An objective and definite sign of midgut volvulus. Small bowel volvulus refers to the abnormal twisting of a loop of bowel around the axis of its own mesentery. Patients typically show features of bowel obstruction abdominal pain distension bilious vomiting or of bowel ischemia and gangrene tachycardia hypotension hematochezia peritonitis in severe cases.
Volvulus in a neonate or infant almost always presents as a midgut volvulus secondary to intestinal malrotation. MeSH terms Adolescent Adult Aged Child Child Preschool. Differential Diagnosis List Small bowel malrotation with midgut volvulus.
Ambulation of duodenum location of the small intestine and colon as well as anatomical position of mesenteric vessels should be intensively observed in order to exclude midgut malrotation. US is the first imaging modality to perform in suspicion of midgut volvulus. It is extremely important to keep a high index of suspicion for this unsuspected condition and recognize that surgery may be lifesaving.
CT Axial non-contrast In this case the typical CT findings of malrotation with midgut volvulus can be seen. CT Axial renal excretory phase CT demonstrates a small bowel obstruction due to a midgut volvulus note the whirlpool sign of the SMA SMV. Although extensive evaluation was performed the diagnosis of intestinal malrotation with chronic volvulus was only established after 5 years.
Chronic midgut volvulus is a rare condition and the diagnosis can pose a serious challenge. Midgut volvulus is the most common complication of malrotation in the adults. Intestinal malrotation and midgut volvulus.
Midgut volvulus the most common serious complication of malrotation can be diagnosed using conventional contrast fluoroscopy US or CT. Midgut volvulus symptoms include chronic abdominal pain nausea bloating or flatulence the appearance of blood in the stool vomiting constipation and finally severe inflammation and swelling of the abdomen. Computed tomography CT appearances of small bowel malrotation and midgut volvulus MGV have rarely been described in paediatric patients.
10 Ott DJ Chen MY. CT is a quick and comprehensive examination in the evaluation of complex acute abdominal pathology in children. It presents with duodenal obstruction and bile emesis.
When the CT findings suggested a midgut volvulus an expedited and abbreviated upper GI examination confirmed the CT findings of a midgut volvulus Fig. Axial CT B C and 3D-MDCT angiography D E images in arterial phase B D and venous phaseC E depicting rotational abnormality of mesenteric. Specific acute colonic disorders.
CT scan can play an important role in the evaluation of patients with this abnormalit. Oblique digital subtraction angiogram A of patient depicting barbers pole sign arrows due to rotations of superior mesenteric artery and its branches. 6Accompanied by other malformations.
When inconclusive CT is in our opinion the next stage in the diagnostic work-up. 5 and showed complete obstruction at that level. We present the case of an 8 year old girl with a long-standing history of atypical gastrointestinal symptoms.
The CT whirl or whirlpool sign describes the swirling appearance of bowel and mesentery twisted around the SMA axis. The complex and sometimes controversial subject of malrotation and midgut volvulus is reviewed commencing with the 19th-century bohemian anatomist václav treitz who described the suspensory muscle anchoring of the duodenal-jejunal junction in the left upper quadrant and continuing with william ladd the 20th-century american father of. The severity may be mild at first but as the disease progresses symptoms can quickly become serious.
This twisting may produce mechanical obstruction vascular compromise or both. Clockwise whirlpool sign at color Doppler US. Additional CT finding is the distension of several small bowel loops due to obstruction.
Volvulus was seen in 65. The signs may be intermittent or minimal. The findings of the CT images compatible with small bowel obstruction due to mesenteric volvulus which presented with whirl or whirlpool sign.
Because of worsening respiratory failure the exploratory laparotomy was performed under general anesthesia in the intensive care unit.
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