intestinale Malrotation mit Volvulus

Newborn with

bilious vomitingTwo 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.The diagnosis was malrotation with midgut volvulus.

Infant with

bilious vomiting for several days and a tender abdomen. AXR supine shows multiple dilated loops of bowel with thickened walls.The diagnosis was small bowel obstruction. In the operating room the patient was found to have malrotation with midgut volvulus. The small bowel was non-viable.

Infant with

bilious vomiting. AP image from an upper GI (left) shows the ligament of Treitz projecting over the right pedicle of the L2 vertebral body and to be lower in position than the duodenal bulb that projects over the right pedicle of the L1 vertebral body. The spiral appearance of the proximal jejunum is best appreciated on the lateral image (right).The diagnosis was malrotation with midgut volvulus.

Teenager with

chronic abdominal pain. AP image from a small bowel follow through exam (below) shows the small bowel on the right side of the abdomen and the colon on the left side of the abdomen. Close examination of the upper GI portion of the exam (above) beyond the abnormal position of the ligament of Treitz shows a thickened appearance of the folds throughout the duodenum (above left) and proximal jejunum (above right) but there was no evidence of spiraling of the bowel or obstruction.The diagnosis on the upper GI was malrotation without midgut volvulus. In the operating room the patient was found to have malrotation with chronic midgut volvulus with chronically dilated lymphatic and mesenteric venous systems which were the cause of the thickened appearance of the small bowel folds.

Newborn with

bilious vomiting. AP image from an upper GI shows complete obstruction of the duodenum at the junction of the second and third parts of the duodenum and associated massive gastroesophageal reflux. A final image taken 5 minutes later was unchanged.The diagnosis was gastroesophageal reflux due to malrotation with midgut volvulus causing duodenal obstruction.

Midgut

volvulus in an infant with intestinal malrotation. Ultrasonography without colour Doppler showing an inversion of the position of the SMA and the SMV.

Midgut

volvulus in an infant with intestinal malrotation. Ultrasonography with colour Doppler showing an inversion of the position of the SMA and SMV.

Midgut

volvulus in an infant with intestinal malrotation. Ultrasonography showing an epigastric mass with a typical whirlpool pattern (arrow).

Midgut

volvulus in an infant with intestinal malrotation. Abdominal radiograph revealing paucity of bowel gas distal to the duodenum.

Midgut

volvulus in an infant with intestinal malrotation. Upper gastrointestinal imaging at delayed phase revealing dilated stomach and proximal duodenum with stagnation of the contrast.