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Malrotation With Midgut Volvulus
Etiology: prerequisite is malrotation with narrow mesenteric root
AXR: usually unremarkable
UGI: malposition of duodenal-jejunal junction and often a spiral / corkscrew appearance to the duodenum / proximal jejunum which is a demonstration of the volvulized bowel
Treatment: Ladd’s procedure
Clinical: bilious vomiting is radiological and surgical emergency as strangulation sequence can happen in few hours: malrotation -> narrow mesenteric root -> volvulus -> venous obstruction -> continued arterial inflow -> venous congestion -> raised tissue pressure above blood pressure -> cessation of arterial flow / arterial obstruction -> midgut necrosis from jejunum to middle of colon
Cases of Malrotation With Midgut Volvulus
Two AP images from an upper GI exam show the duodenal-jejunal junction to be to the left of the spine but to be low lying. The proximal jejunum has a spiral appearance.Surgical image shows the entire small bowel, from the jejunum to the terminal ileum, to be infarcted.