Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You and Your Team.

Learn More →

Image of the Month—Diagnosis

Image of the Month—Diagnosis Answer: Midgut Volvulus At laparotomy, 2 L of ascites was suctioned out and the entire intraperitoneal small bowel was found to be ischemic. Volvulus of the small-bowel mesentery was the etiologic factor (the 71-year-old patient had a congenital malrotation). The small-bowel mesentery was detorsed in a counterclockwise fashion, resulting in an immediate change from ischemic (purple) bowel to a normal appearance with almost immediate restoration of peristalsis. Adhesiolysis was performed on a band connecting a proximal loop of jejunum, restoring its blood supply. Lysis of bands lateral to the cecum and ascending colon was undertaken. The retrocecal appendix and base of the cecum were above the level of the umbilicus; appendectomy and cecopexy were performed. Small-bowel mesenteric volvulus in patients with congenital malrotation is a rare cause of intestinal ischemia in adults. Midgut volvulus is most commonly seen in neonates, and it is a surgical emergency. Embryologically, malrotation occurs when the fetal midgut returns to the abdominal cavity at about 10 to 12 weeks; normally, there is a 270° counterclockwise rotation, but this is arrested at varying degrees in malrotation. Ladd bands can occur across the duodenum, sometimes resulting in obstruction.1 On computed tomographic scan, a swirl pattern is often seen. In Figure 1, tissue is seen rotating around the superior mesenteric artery. In Figure 2, a twisting of the small bowel mesentery is demonstrated. Because the location of the appendix is abnormal, appendectomy is performed to prevent future diagnostic uncertainty. In this patient, there is a possibility that her diet contributed to her condition. Duke and Yar2 reported that there was a “striking increase in the frequency” of primary small-bowel volvulus in Afghani Muslim men during Ramadan. This was hypothesized to be secondary to high fiber intake following fasting. Return to Quiz Case. Back to top Article Information Correspondence: Terrence I. McKee, MD, Department of General Surgery, Heritage Valley Health System, 1000 Dutch Ridge Road, Beaver, PA 15009 (stmckee@comcast.net). Accepted for Publication: May 17, 2011. Financial Disclosure: None reported. Additional Contributions: Imaging was reviewed with George Galanis, MD, and the intraoperative photograph was taken by Ken Chapman, RN, Waynesboro Hospital, Waynesboro, Pennsylvania.Box Reference Submissions The Editor welcomes contributions to the Image of the Month. Manuscripts should be submitted via our online manuscript submission and review system (http://manuscripts.archsurg.com). Articles and photographs accepted will bear the contributor's name. Manuscript criteria and information are per the Instructions for Authors for Archives of Surgery (http://archsurg.ama-assn.org/misc/ifora.dtl). No abstract is needed, and the manuscript should be no more than 3 typewritten pages. There should be a brief introduction, 1 multiple-choice question with 4 possible answers, and the main text. No more than 2 photographs should be submitted. There is no charge for reproduction and printing of color illustrations. References 1. Schwartz S. Principles of Surgery. 7th ed. New York, NY: McGraw-Hill; 1999:1730-1732 2. Duke JH Jr, Yar MS. Primary small bowel volvulus: cause and management. Arch Surg. 1977;112(6):685-688860919PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Image of the Month—Diagnosis

Archives of Surgery , Volume 147 (2) – Feb 20, 2012
Download PDF
1 page
Read Article

Image of the Month—Diagnosis

Abstract

Answer: Midgut Volvulus At laparotomy, 2 L of ascites was suctioned out and the entire intraperitoneal small bowel was found to be ischemic. Volvulus of the small-bowel mesentery was the etiologic factor (the 71-year-old patient had a congenital malrotation). The small-bowel mesentery was detorsed in a counterclockwise fashion, resulting in an immediate change from ischemic (purple) bowel to a normal appearance with almost immediate restoration of peristalsis. Adhesiolysis was performed on a...
Loading next page...
 
/lp/american-medical-association/image-of-the-month-diagnosis-kqhNzYCz0k
Publisher
American Medical Association
Copyright
Copyright © 2012 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.147.2.196
Publisher site
See Article on Publisher Site

Abstract

Answer: Midgut Volvulus At laparotomy, 2 L of ascites was suctioned out and the entire intraperitoneal small bowel was found to be ischemic. Volvulus of the small-bowel mesentery was the etiologic factor (the 71-year-old patient had a congenital malrotation). The small-bowel mesentery was detorsed in a counterclockwise fashion, resulting in an immediate change from ischemic (purple) bowel to a normal appearance with almost immediate restoration of peristalsis. Adhesiolysis was performed on a band connecting a proximal loop of jejunum, restoring its blood supply. Lysis of bands lateral to the cecum and ascending colon was undertaken. The retrocecal appendix and base of the cecum were above the level of the umbilicus; appendectomy and cecopexy were performed. Small-bowel mesenteric volvulus in patients with congenital malrotation is a rare cause of intestinal ischemia in adults. Midgut volvulus is most commonly seen in neonates, and it is a surgical emergency. Embryologically, malrotation occurs when the fetal midgut returns to the abdominal cavity at about 10 to 12 weeks; normally, there is a 270° counterclockwise rotation, but this is arrested at varying degrees in malrotation. Ladd bands can occur across the duodenum, sometimes resulting in obstruction.1 On computed tomographic scan, a swirl pattern is often seen. In Figure 1, tissue is seen rotating around the superior mesenteric artery. In Figure 2, a twisting of the small bowel mesentery is demonstrated. Because the location of the appendix is abnormal, appendectomy is performed to prevent future diagnostic uncertainty. In this patient, there is a possibility that her diet contributed to her condition. Duke and Yar2 reported that there was a “striking increase in the frequency” of primary small-bowel volvulus in Afghani Muslim men during Ramadan. This was hypothesized to be secondary to high fiber intake following fasting. Return to Quiz Case. Back to top Article Information Correspondence: Terrence I. McKee, MD, Department of General Surgery, Heritage Valley Health System, 1000 Dutch Ridge Road, Beaver, PA 15009 (stmckee@comcast.net). Accepted for Publication: May 17, 2011. Financial Disclosure: None reported. Additional Contributions: Imaging was reviewed with George Galanis, MD, and the intraoperative photograph was taken by Ken Chapman, RN, Waynesboro Hospital, Waynesboro, Pennsylvania.Box Reference Submissions The Editor welcomes contributions to the Image of the Month. Manuscripts should be submitted via our online manuscript submission and review system (http://manuscripts.archsurg.com). Articles and photographs accepted will bear the contributor's name. Manuscript criteria and information are per the Instructions for Authors for Archives of Surgery (http://archsurg.ama-assn.org/misc/ifora.dtl). No abstract is needed, and the manuscript should be no more than 3 typewritten pages. There should be a brief introduction, 1 multiple-choice question with 4 possible answers, and the main text. No more than 2 photographs should be submitted. There is no charge for reproduction and printing of color illustrations. References 1. Schwartz S. Principles of Surgery. 7th ed. New York, NY: McGraw-Hill; 1999:1730-1732 2. Duke JH Jr, Yar MS. Primary small bowel volvulus: cause and management. Arch Surg. 1977;112(6):685-688860919PubMedGoogle ScholarCrossref

Journal

Archives of Surgery – American Medical Association

Published: Feb 20, 2012

Keywords: intestine, small,malrotation, congenital,intestinal volvulus,mesentery

References

  • Principles of Surgery.
    Schwartz S
  • Primary small bowel volvulus: cause and management.
    Duke JH; Yar MS

You’re reading a free preview. Subscribe to read the entire article.

Try 2 weeks free now

DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

or browse the journals available

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$499/year

Save searches from
Google Scholar,
PubMed

Create folders to
organize your research

Export folders, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

Sign up
for free
Start 14 day
Free Trial