Peds

Midgut Volvulus

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Midgut Volvulus, Small Bowel Volvulus, Duodenal Volvulus, Congenital Volvulus, Double Bubble Sign

  • 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
    1. Associated with Intestinal Malrotation
    2. Presents in infants in 90% of cases
  • Symptoms
  • Midgut Volvulus (infants and children)
  1. Infants
    1. Bilious Emesis
    2. Sudden onset of Abdominal Pain
  2. Older children
    1. Chronic intermittent Vomiting and abdominal cramping
    2. Failure to Thrive
    3. Constipation
    4. Bloody Diarrhea
  • Signs
  1. Abdominal exam may be benign
  2. Heme positive stool
    1. Late sign suggesting infarcted bowel
  • Differential Diagnosis
  1. See Abdominal Pain Causes
  • 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)
  • Complications
  1. Intestinal infarction (high mortality)
  • Management
  1. Emergent surgical management
    1. Mesenteric Infarction and necrosis starts within first 3 hours of onset
  • Resources
  1. Hebra (2012) Intestinal Volvulus, Medscape