Midgut Volvulus: Acute Abdomen in an Adult Patient

Abstract

Abstract:Midgut malrotation is an anomaly of intestinal rotation which occurs during fetal development and usually presents in the neonatal period. It is rare for malrotation to present in adulthood. The main purpose of this paper is to show how the clinical picture may be expected to vary and to emphasize the importance of "shock" in massivevolvulus. We present a case of midgut volvulus in an adult male patient (60 year old) who presented with cramping generalized right abdominal pain and vomiting of two days duration. An abdominal ultrasound showed peritoneal effusion and greek distension. An emergency laparotomy showed typical Ladd's bands and small bowel distension. All the intestine from the duodenum to the left colic flexure was found to be suspended on a single dorsal mesentery. This mesentery arose from a narrow base high up in the abdomen and reached down to the pelvic brim. There were numerous areas of fine shiny fibrosis on the small bowel corresponding to sites of previous constriction when a midgut volvulus occurred. A detorsion of the twisted mesentery, lysis of the bands, appendectomy were performed. Complete resolution of symptoms is noted. Acute volvulus of the small intestine is one of the most serious abdominal emergencies. Diagnosis may be difficult and delay in operative intervention can be disastrous.

Intestinal Malrotation with Midgut Volvulus leading to Small Bowel Obstruction in a Young Adult: A Case Report

“…3 Acute presentation, though uncommon, may present with intestinal ischemia and gangrene which has disastrous consequences. 10 In adults, the diagnosis requires a high index of suspicion because timely recognition is the key to survival.…”