Small Bowel Volvulus

  • Etiology: small bowel twists around an intra-abdominal mass (Meckel’s diverticulum, mesenteric cyst, ileal duplication) or adhesion
  • AXR: small bowel obstruction
  • US + CT: whirlpool sign
  • DDX: malrotation with midgut volvulus
  • Complications: closed loop bowel obstruction, bowel ischemia and necrosis
  • Treatment: surgical

Cases of Small Bowel Volvulus

CT of small bowel volvulus around mesenteric cyst
Two contiguous axial images from a CT with contrast of the abdomen show a whirlpool sign of swirling of the mesenteric vessels (above left) around a round low density structure just to the left of the spine (above right). Another axial image from the same exam (below left) shows a normal relationship of the superior mesenteric vein to the right of the superior mesenteric artery although both appear to be shifted to the left. AP image from a subsequent upper GI (below right) shows normal position of the ligament of Treitz in the left upper quadrant.
Surgical image of Meckel's diverticulum
Surgical image shows shows multiple dilated loops of small bowel in the background with a sharp transition point seen in the center of the image in the terminal ileum where on its anti-mesenteric border a diverticulum is seen with an omphalomesenteric duct remnant coming off it. This remnant had been attached to the under surface of the umbilicus, serving as a fulcrum for a small bowel volvulus, resulting in a small bowel obstruction.