Midgut Volvulus

Aka: Midgut Volvulus, Small Bowel Volvulus, Duodenal Volvulus, Congenital Volvulus, Double Bubble Sign, Malrotation with Volvulus

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II. Definitions

  1. Volvulus
    1. Twisting of intestinal loop around attachment to mesentery
    2. Can occur at Stomach (Gastric Volvulus), Small Intestine, cecum, transverse colon or sigmoid colon
  2. Midgut Volvulus (Malrotation with Volvulus)
    1. Associated with Intestinal Malrotation
    2. Presents in infants in 90% of cases

III. Epidemiology

  1. Malrotation with Volvulus often presents in first few weeks of life (60% present in first year of life)

IV. Symptoms: Midgut Volvulus (infants and children)

  1. Infants
    1. Bilious Emesis
    2. Sudden onset of Abdominal Pain
    3. May present with Failure to Thrive and "reflux"
  2. Older children
    1. Chronic intermittent Vomiting and abdominal cramping
    2. Failure to Thrive
    3. Constipation
    4. Bloody Diarrhea

V. Signs

  1. Abdominal exam may be benign
  2. Abdominal Distention is often a late finding in acute Volvulus
  3. Heme positive stool
    1. Late sign suggesting infarcted bowel

VI. Differential Diagnosis

  1. See Abdominal Pain Causes

VII. Imaging

  1. Acute Midgut Volvulus (children): Abdominal Xray
    1. Often non-specific
    2. Dilated Stomach and proximal duodenum with intervening pylorus (Double Bubble Sign)
      1. Double-Bubble is also seen in Duodenal Atresia (typically diagnosed in newborn nursery)

VIII. Complications

  1. Intestinal infarction (high mortality)

IX. Management

  1. Acute stabilization
    1. ABC Management
    2. Fluid Resuscitation
    3. Correct Electrolyte abnormalities
    4. Broad spectrum antibiotics for peritonitis
    5. Nasogastric Tube decompression
  2. Emergent surgical management
    1. Mesenteric Infarction and necrosis starts within first 3 hours of onset
    2. Necrotic bowel resected if needed
    3. Ladd Procedure reduces the Volvulus
      1. Bowel rotated counter-clockwise
      2. Mesenteric bands (Ladd Bands) are divided
      3. Small Bowel placed on the right side of Abdomen
      4. Large Bowel placed on the left side of Abdomen
      5. Appendectomy
      6. Widens mesenteric pedicle and reduces risk of Volvulus recurrence (but does not correct malrotation)

X. Resources

  1. Hebra (2012) Intestinal Volvulus, Medscape

XI. References

  1. Jones (2022) Crit Dec Emerg Med 36(2): 14-5
  2. Lampl (2012) Pediatr Radiol 39:359-66 [PubMed]
  3. Laurence (2012) Pediatr Emerg Care 28(1): 87-9 [PubMed]

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Related Studies

Ontology: Congenital malrotation of intestine (C0221210)

Definition (NCI) A congenital abnormality in which the intestine is abnormally rotated (twisted). It may result in intestinal obstruction.
Concepts Congenital Abnormality (T019)
MSH C562456
SnomedCT 29980002, 204756000, 48641006
English Incomplete rotation intestine, Volvulus neonatorum, Volvulus of midgut, VOLVULUS OF MIDGUT, Malrotation of the gut, Malrotation of gut, intestinal malrotation, intestinal malrotation (diagnosis), Gut malrotation, Congenital malrotation of intestine, congenital malrotation, intestine malrotation, midgut volvulus, intestines malrotation, volvulus neonatorum, malrotation intestine, Intestinal Malrotation, Volvulus Of Midgut, Malrotation of bowel, Congenital Malrotation of Intestine, Malrotation of intestine, Incomplete rotation of intestine, Congenital malrotation (morphologic abnormality), Congenital malrotation of intestine (disorder), Congenital malrotation, bowel; malrotation, malrotation; bowel, Congenital malrotation, NOS, Intestinal malrotation
Dutch malrotatie van darmen, darm; malrotatie, malrotatie; darm
French Anomalie de la rotation intestinale
Italian Malrotazione intestinale
Portuguese Má rotação intestinal
Spanish Malrotación intestinal, malrotación congénita del intestino (trastorno), malrotación congénita del intestino, rotación anómala congénita de intestino (trastorno), rotación anómala congénita de intestino, rotación patológica de origen congénito (anomalía morfológica), rotación patológica de origen congénito
Japanese 腸回転異常, ﾁｮｳｶｲﾃﾝｲｼﾞｮｳ
Czech Abnormální rotace sttřev
Hungarian Intestinalis malrotatio
German Malrotation
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Volvulus of the small bowel (C0238199)

Concepts Pathologic Function (T046)
SnomedCT 197058003
Dutch volvulus van dunne darm
French Volvulus de l'intestin grêle
German Volvulus des Duenndarms
Italian Volvolo dell'intestino tenue
Portuguese Vólvulo do intestino delgado
Spanish Vólvulo de intestino delgado, vólvulo del intestino delgado (trastorno), vólvulo del intestino delgado
Japanese 小腸捻転, ｼｮｳﾁｮｳﾈﾝﾃﾝ
English small intestine volvulus, small intestine volvulus (diagnosis), small bowel volvulus, volvulus of the small bowel, Volvulus of small intestine, Volvulus of the small bowel, Volvulus of the small bowel (disorder), Volvulus of small bowel
Czech Volvulus tenkého střeva
Hungarian Vékonybél volvulusa
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Volvulus of duodenum (C0267354)

Concepts Disease or Syndrome (T047)
ICD10 K31.5
SnomedCT 79812002
English duodenal volvulus, duodenal volvulus (diagnosis), Volvulus of duodenum, Duodenal volvulus, Volvulus of duodenum (disorder)
Spanish vólvulo de duodeno (trastorno), vólvulo de duodeno
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Congenital volvulus (C0345252)

Concepts Congenital Abnormality (T019)
SnomedCT 204768009, 253786009
English congenital volvulus, congenital volvulus (diagnosis), Congenital volvulus, Congenital volvulus (disorder), congenital; volvulus, volvulus; congenital
Dutch congenitaal; volvulus, volvulus; congenitaal
Spanish vólvulo congénito (trastorno), vólvulo congénito
Derived from the NIH UMLS (Unified Medical Language System)

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