The large intestine
Paul Ong, Rachel Skittrall in Gastrointestinal Nursing, 2017
There are three types of volvulus: midgut, caecal and sigmoid volvulus. A midgut volvulus is diagnosed when there is a twisting of the small bowel around its mesenteric artery axis resulting in intestinal obstruction and an interruption of blood circulation leading to bowel ischaemia and necrosis (Papadimitriou et al., 2011). Volvulus of the small intestine is relatively uncommon and is associated with some form of a malrotation (Roggo and Ottinger, 1992). A midgut volvulus can be primary, that is without any underlying cause, or secondary to birth defects or acquired conditions. Small bowel volvulus is potentially life threatening, because of the risks of intestinal ischaemia, and therefore requires immediate surgical intervention. Primary midgut volvulus is more frequent in children and young adults and is rarely present in adults in whom secondary volvulus is more prevalent (Papadimitriou et al., 2011; Chi Ho Y, 2012). The annual incidence of midgut volvulus is smaller in Western countries (1.7–5.7 per 100,000 population) and larger in Africa and Asia (24–60 per 100,000 population) (Iwuagwu and Deans, 1999).
Abnormal Anatomy of the Stomach and Duodenum
John F. Pohl, Christopher Jolley, Daniel Gelfond in Pediatric Gastroenterology, 2014
The arrest of intestinal rotation may be complete (nonrotation), or can take place at any stage following the initial counterclockwise 180 degree movement. Nonrotation is an example of early failure of rotation and is considered a misnomer as the initial 90 degree rotation is completed. However, without further rotation, the small bowel is located on the right side while the colon occupies the left side of the abdomen (12.10). In addition, there are rare variants of nonrotation affecting only the duodenum and small bowel. Incomplete rotation (malrotation) is more common and may present during the neonatal period. Midgut volvulus is a frequent complication of malrotation occurring in utero or postnatally. Abnormally rotated bowel does not develop a normal mesenteric attachment, rendering the intestine excessively mobile and at a high risk for volvulus leading to bowel ischemia. Peritoneal bands (Ladd’s bands) form due to disordered fixation of the malpositioned bowel associated with incomplete cecal descent. Ladd’s bands are often found anterior to the duodenum causing extrinsic compression and bowel obstruction.
Paediatric cases
Lt Col Edward Sellon, David C Howlett, Nick Taylor in Radiology for Medical Finals, 2017
Because the DJ and ileocaecal junctions are not in their normal positions (malrotated), the base of the small bowel mesentery, which extends between these two points, is narrow. This predisposes to twisting of the bowel known as midgut volvulus. The bowel twists around the mesenteric vessels, which can lead to fatal midgut strangulation; hence the need for emergency treatment if a diagnosis of malrotation is being considered.What are the differential diagnoses?
Massive ascites and severe pulmonary hypoplasia in a premature infant with meconium peritonitis and congenital cytomegalovirus infection
Published in Fetal and Pediatric Pathology, 2020
During normal fetal development, the gastrointestinal tract herniates out of the abdominal cavity, undergoes a 270° counterclockwise rotation around the superior mesenteric artery, and returns to the abdominal cavity. The duodenojejunal loop is then fixed to the left of the midline and the cecum to the right lower quadrant. If this process is interrupted at any point during fetal development, the result is known as intestinal malrotation, which can lead to a range of gastrointestinal abnormalities, the most common of which being midgut volvulus.
Protective Effects of Hydrogen-Rich Saline on Experimental Intestinal Volvulus in Rats
Published in Journal of Investigative Surgery, 2022
Hayrunnisa Oral, Zafer Türkyılmaz, Ramazan Karabulut, Cem Kaya, Duygu Dayanır, Cengiz Karakaya, Kaan Sonmez
Midgut volvulus is frequently seen due to malrotation, with approximately 50% of the cases occurring in the first week of life and more than 60% in the first month of the neonatal period. The intestinal volvulus is formed by the rotation of the small intestines around their mesenteric pedicle and superior mesenteric vessels [21, 22]. The obstruction by the volvulus first affects lymphatic drainage, followed by disruption of the venous drainage and arterial blood flow due to the increased pressure [23]. Subsequently, an ischemic state ensues.
Primary midgut volvulus without intestinal malrotation in a young adult: a case report
Published in Acta Chirurgica Belgica, 2020
Nicolas De Hous, Charles de Gheldere, Rodrigo Salgado, Filip Gryspeerdt
Midgut volvulus is a well-known complication of intestinal malrotation usually occurring in infants and young children [2]. In contrast, primary midgut volvulus occurs in the setting of normal intestinal rotation and mesenteric fixation. This condition is extremely rare, with only a handful of cases described in the literature. In this report, we present the rare case of a young adult with a midgut volvulus in whom no underlying cause could be identified.
Related Knowledge Centers
- Abdominal Pain
- Bloating
- Constipation
- Fever
- Gastrointestinal Tract
- Mesentery
- Blood
- Bowel Obstruction
- Blood In Stool
- Intestinal Ischemia