Intestinal malrotation and midgut volvulus

Area of Science:

• Pediatric Surgery
• Diagnostic Imaging
• Congenital Abnormalities

Background:

• Intestinal malrotation is a congenital anomaly where bowel loops are abnormally positioned, leading to a shortened mesentery.
• This anatomical variation predisposes infants to midgut volvulus, a surgical emergency characterized by twisting of the bowel.
• Persistent bilious vomiting in neonates is a critical sign warranting urgent diagnostic evaluation.

Observation:

• A four-day-old infant presented with persistent bilious vomiting, bloody stools, and abdominal distension.
• Transabdominal ultrasound identified a right upper quadrant mass and the characteristic whirlpool sign on color Doppler.
• Abdominal radiography yielded nonspecific findings, while upper gastrointestinal series confirmed duodenal obstruction.

Findings:

• The sonographic whirlpool sign is a highly specific indicator of midgut volvulus.
• Ultrasound, particularly with color Doppler, can rapidly diagnose intestinal malrotation with midgut volvulus.
• Surgical intervention was promptly performed following diagnosis.

Implications:

• Early diagnosis via ultrasound can prevent catastrophic complications associated with midgut volvulus.
• The whirlpool sign on ultrasound obviates the need for further imaging in many cases, expediting surgical planning.
• This case highlights the critical role of ultrasound in the timely management of neonatal intestinal emergencies.