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

UGI 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
Surgical image shows the entire small bowel, from the jejunum to the terminal ileum, to be infarcted.