Midgut volvulus and intestinal malrotation

Last updated: May 9, 2022

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Volvulus is defined as the twisting of a loop of bowel on its mesentery and is one of the most common causes of intestinal obstruction. Volvulus in a neonate or infant almost always presents as a midgut volvulus secondary to intestinal malrotation. 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. Upper GI series is the investigation of choice in infants with suspected midgut volvulus, which is seen as a cork-screw duodenum. The Ladd procedure (laparotomy and detorsion of the volvulus) is indicated in all patients with intestinal malrotation since it is impossible to predict if volvulus of the midgut will occur in an asymptomatic patient or not.

See “Sigmoid volvulus and cecal volvulus” for more details of volvulus occurring in adults.

SigmOid volvulus is more common in Older individuals while Midgut volvulus and Malrotation are more common in Minors.

Epidemiological data refers to the US, unless otherwise specified.

Common types of intestinal malrotation [3][4][5]
Nonrotation Incomplete rotation
  • The mesenteric attachment has a wider base than in incomplete rotation

Intestinal malrotation and midgut volvulus

Imaging in intestinal malrotation and midgut volvulus

Intestinal malrotation

Midgut volvulus

Upper GI series (gold standard in hemodynamically stable patients) [5][10]

  • Displaced duodenojejunal junction
  • The small bowel is right-sided.
  • Duodenal obstruction
  • Corkscrew duodenum
Barium enema (lower GI series)
Abdominal ultrasound [11]

CECT scan (oral and IV contrast)

Abdominal x-ray

References:[5][8][9][10][11][12][13][14][15]

References:[16][17]

The differential diagnoses listed here are not exhaustive.

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  18. Midgut volvulus. https://radiopaedia.org/articles/midgut-volvulus. Updated: March 28, 2017. Accessed: March 28, 2017.

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