Midgut Volvulus

WHAT IS THE PATHOPHYSIOLOGY OF MALROTATION WITH MIDGUT

VOLVULUS?
In early fetal development (by 3
rd
month rotation should be complete) the midgut, small bowel,
right colon and 1/3 of he transverse colon do not undergo appropriate rotation and retroperitoneal
fixation as abdominal contents return to the abdominal cavity
Normally duodenum fixed in !" retroperitoneum and cecum in #" with malrotation both the
duodenum and cecum, are suspended near each other in the midgut on their vascular stal$
containing the %&'
(wisting of the midgut occurs at the distal duodenum or proximal )e)unum on the %&' tethered
on a narrow pedicle, add*s bands can cause obstruction at the level of the duodenum
+owel necrosis can occur within ,hr of initial presentation
-./ of all midgut volvulus occur in 1
st
month of life
WHAT IS THE CLINICAL PRESENTATION OF MIDGUT VOLVULUS?
+ilious vomiting (-.01../ of cases)
'bdominal distension
1ematoche2ia
%hoc$
3hronic intermittent vomiting or abdominal pain
4ailure to thrive
4eeding difficulties
WHAT DIAGNOSTIC TESTS ARE USEFUL IN DIAGNOSING MIDGUT VOLVULUS?
'bdominal xray
,./ normal
%igns of bowel obstruction
&ar$edly dilated gastric bubble ad duodenal bulb
5ouble bubble
!6I
6old standard
%piral cor$screw of )e)unum
'bnormal position o duodenal c0loop
!/%
'bnormal position of c0loop duodenum and %&'
%hould be followed by !6I o confirm diagnosis
A DOULE ULE SIGN ON ADOMINAL !RAYS CAN E SEEN WITH WHAT "
CONDITIONS?
5uodenal atresia
&alrotation with midgut volvulus
17% (dilated body of stomach and pylorus)
WHAT IS THE MANAGEMENT OF MALROTATION WITH MIDGUT VOLVULUS?
8mergent surgery consult
Iv fluid resuscitation
N6 decompression of stomach
!6I emergently if patient is stable
+road spectrum antibiotics I bowel necrosis suspected
REFERENCES
%harieff, 6"9 Newborn emergencies : (he first 3. 5ays of life9 Peds Clin N Am9 ,..;<=3:;>0-?
ouie, @79 8ssential 5iagnosis of 'bdominal 8mergencies in the first year of life9 Emerg Med
Clin N Am9 ,..A<,=:1..>01.?.
&arx: #osen Bs 8mergency &edicine ,..;9 3h 1A.
+ehrman: Nelson (extbo$ of pediatrics9 ,..? 3h 311, 31,,31?