eMedicine Specialties > Pediatrics: General Medicine > Gastroenterology

Intestinal Volvulus: Multimedia

Author: Andre Hebra, MD, Chief, Division of Pediatric Surgery, Medical University of South Carolina; Professor of Surgery and Pediatrics, Medical University of South Carolina
Coauthor(s): Melissa Miller, MD, Department of Surgery, Medical University of South Carolina
Contributor Information and Disclosures

Updated: Sep 11, 2008

Multimedia

Upper GI contrast study of a 10-year-old patient ...
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Media file 1: Upper GI contrast study of a 10-year-old patient with intestinal malrotation. Note the normal appearance of the stomach but the abnormally shaped duodenum. The duodenum does not have the C-loop appearance, it does not cross back over the midline (spine), and the proximal jejunum is located on the right side of the abdomen. In addition, this patient had a partial volvulus illustrated by the corkscrew appearance of the duodenum.
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Upper GI contrast study of a 10-year-old patient ...

Upper GI contrast study of a 10-year-old patient with intestinal malrotation. Note the normal appearance of the stomach but the abnormally shaped duodenum. The duodenum does not have the C-loop appearance, it does not cross back over the midline (spine), and the proximal jejunum is located on the right side of the abdomen. In addition, this patient had a partial volvulus illustrated by the corkscrew appearance of the duodenum.

Upper GI contrast study of a full-term newborn ba...
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Media file 2: Upper GI contrast study of a full-term newborn baby with bilious vomiting. Note the obstruction at the third and fourth portion of the duodenum with the "bird beak" appearance, which is compatible with a midgut volvulus and malrotation.
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Upper GI contrast study of a full-term newborn ba...

Upper GI contrast study of a full-term newborn baby with bilious vomiting. Note the obstruction at the third and fourth portion of the duodenum with the "bird beak" appearance, which is compatible with a midgut volvulus and malrotation.

Barium enema of a 1-year-old infant with a histor...
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Media file 3: Barium enema of a 1-year-old infant with a history of intermittent bilious vomiting. The colon is positioned abnormally, with most of the colon on the left side of the abdomen. Note the cecum and terminal ileum in the left upper quadrant of the abdomen.
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Barium enema of a 1-year-old infant with a histor...

Barium enema of a 1-year-old infant with a history of intermittent bilious vomiting. The colon is positioned abnormally, with most of the colon on the left side of the abdomen. Note the cecum and terminal ileum in the left upper quadrant of the abdomen.

CT scan appearance of a 4-year-old patient with i...
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Media file 4: CT scan appearance of a 4-year-old patient with intermittent episodes of bilious vomiting. The CT scan was performed at the time of volvulation of the midgut. Note the "hurricane" or swirl appearance in the mid abdomen at the site of the narrow pedicle of the superior mesenteric artery, which is compatible with the acute twist observed during a midgut volvulus.
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CT scan appearance of a 4-year-old patient with i...

CT scan appearance of a 4-year-old patient with intermittent episodes of bilious vomiting. The CT scan was performed at the time of volvulation of the midgut. Note the "hurricane" or swirl appearance in the mid abdomen at the site of the narrow pedicle of the superior mesenteric artery, which is compatible with the acute twist observed during a midgut volvulus.

<a name="#target5"> </a>Operative photograph...
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Media file 5:  Operative photograph illustrating the midgut volvulus of the baby whose upper GI series was shown in Image 2. Note the complete twist (>360°) of the entire small bowel over the narrow pedicle of its mesentery. Note the appearance of the small bowel and congestion and cyanosis due to vascular compromise from the volvulus. Fortunately, early operative intervention prevented the development of necrosis, and emergent untwisting combined with a Ladd procedure was successful.
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<a name="#target5"> </a>Operative photograph...

 Operative photograph illustrating the midgut volvulus of the baby whose upper GI series was shown in Image 2. Note the complete twist (>360°) of the entire small bowel over the narrow pedicle of its mesentery. Note the appearance of the small bowel and congestion and cyanosis due to vascular compromise from the volvulus. Fortunately, early operative intervention prevented the development of necrosis, and emergent untwisting combined with a Ladd procedure was successful.

Operative photograph of a midgut volvulus due to ...
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Media file 6: Operative photograph of a midgut volvulus due to intestinal malrotation in a 10-year-old patient. Note the twisting at the base of the mesentery with evidence of intestinal congestion and ischemia but no necrosis.
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Operative photograph of a midgut volvulus due to ...

Operative photograph of a midgut volvulus due to intestinal malrotation in a 10-year-old patient. Note the twisting at the base of the mesentery with evidence of intestinal congestion and ischemia but no necrosis.

Diagram illustrating the operative maneuver to un...
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Media file 7: Diagram illustrating the operative maneuver to untwist the volvulized midgut. Note that the untwisting is performed in a counterclockwise fashion by the operating surgeon. Once this is accomplished, the Ladd procedure is completed by dividing any obstructing bands and by broadening the base of the mesentery.
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Diagram illustrating the operative maneuver to un...

Diagram illustrating the operative maneuver to untwist the volvulized midgut. Note that the untwisting is performed in a counterclockwise fashion by the operating surgeon. Once this is accomplished, the Ladd procedure is completed by dividing any obstructing bands and by broadening the base of the mesentery.

Operative photograph of a patient with a midgut v...
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Media file 8: Operative photograph of a patient with a midgut volvulus in which the diagnosis was made late. Note that the entire small bowel is necrotic and nonviable. This infant did not survive.
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Operative photograph of a patient with a midgut v...

Operative photograph of a patient with a midgut volvulus in which the diagnosis was made late. Note that the entire small bowel is necrotic and nonviable. This infant did not survive.

More on Intestinal Volvulus

Overview: Intestinal Volvulus
Differential Diagnoses & Workup: Intestinal Volvulus
Treatment & Medication: Intestinal Volvulus
Follow-up: Intestinal Volvulus
Multimedia: Intestinal Volvulus
References
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References

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Further Reading

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Keywords

intestinal volvulus, intestinal malrotation, volvulus, midgut volvulus, cecal malposition, cecal volvulus, gastrointestinal malrotation, GI malrotation, mesenteric twisting, nonfixation of the intestines, congenital duodenal obstruction, nonrotation, Ladd's procedure, Ladd procedure, Ladd's bands, Ladd bands, gastroschisis, diaphragmatic hernias, hyperrotation, ischemia, mucosal necrosis, intramural air formation, gram-negative sepsis, perforation, peritonitis, malnutrition, short-bowel syndrome, renal failure, hepatic failure, adhesive obstruction, intussusception, bilious vomiting, anorexia, intermittent apnea, failure to thrive, cyclic vomiting, dehydration, lethargy, respiratory distress, Down syndrome, trisomy 21, congenital heart disease, imperforate anus, omphalocele, duodenal atresia, duodenal stenosis, diaphragmatic hernia, Meckel diverticulum, VACTERL, esophageal atresia, pyloric stenosis, erythroblastosis, cystic fibrosis, meconium ileus, Hirschsprung disease, duodenal web, biliary atresia

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Contributor Information and Disclosures

Author

Andre Hebra, MD, Chief, Division of Pediatric Surgery, Medical University of South Carolina; Professor of Surgery and Pediatrics, Medical University of South Carolina
Andre Hebra, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Association for Academic Surgery, Society of Laparoendoscopic Surgeons, South Carolina Medical Association, Southeastern Surgical Congress, and Southern Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Melissa Miller, MD, Department of Surgery, Medical University of South Carolina
Melissa Miller, MD is a member of the following medical societies: American Medical Association and American Medical Student Association/Foundation
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey J DuBois, MD, Consulting Staff, Division of Pediatric Surgery, Kaiser Permanente, North Sacramento Medical Center
Jeffrey J DuBois, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Association for Academic Surgery, California Medical Association, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

B U K Li, MD, Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Director, Pediatric Fellowships and Gastroenterology Fellowship, Medical Director, Functional Gastrointestinal Disorders and Cyclic Vomiting Program, Medical College of Wisconsin; Attending Gastroenterologist, Children's Hospital of Wisconsin
B U K Li, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

CME Editor

Steven M Schwarz, MD, FAAP, FACN, AGAF, Professor of Pediatrics, State University of New York, Downstate Medical Center College of Medicine; Distinguished Lecturer, New York Medical College, School of Public Health
Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research
Disclosure: TAP Pharmaceuticals Honoraria Speaking and teaching; Curemark, LLC Consulting fee Board membership

Chief Editor

Carmen Cuffari, MD, Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine
Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

 
 
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