An unexpected cause of small bowel obstruction in an adult patient: midgut volvulus

• Published in: BMJ case reports Vol. 2014; p. bcr2014205178
• Main Authors: Söker, Gökhan, Yılmaz, Cengiz, Karateke, Faruk, Gülek, Bozkurt
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 08.05.2014; BMJ Publishing Group
• Series: Case Report
• Subjects: Abdomen; Abdominal Pain - etiology; Adult; Adults; Barium; Barium Sulfate; Digestive System Abnormalities - complications; Digestive System Abnormalities - diagnosis; Enema; Europe (East); Humans; Intestinal obstruction; Intestinal Obstruction - diagnosis; Intestinal Obstruction - etiology; Intestinal Volvulus - complications; Intestinal Volvulus - diagnosis; Intestine, Small - diagnostic imaging; Intestine, Small - pathology; Ischemia; Male; Mesentery; Reminder of Important Clinical Lesson; Small intestine; Surgery; Tomography, X-Ray Computed; Ultrasonic imaging; Ultrasonography, Doppler, Color; Veins & arteries; White
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2014-205178

The most important complication of intestinal malrotation is midgut volvulus because it may lead to intestinal ischaemia and necrosis. A 29-year-old male patient was admitted to the emergency department with abdominal pain. Ultrasonography (US), colour Doppler ultrasonography (CDUS), CT and barium studies were carried out. On US and CDUS, twisting of intestinal segments around the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) and alteration of the SMA–SMV relationship were detected. CT demonstrated that the small intestine was making a rotation around the SMA and SMV, which amounted to more than 360°. The upper gastrointestinal barium series revealed a corkscrew appearance of the duodenum and proximal jejunum, which is a pathognomonic finding of midgut volvulus. Prior knowledge of characteristic imaging findings of midgut volvulus is essential in order to reach proper diagnosis and establish proper treatment before the development of intestinal ischaemia and necrosis.