A rare cause of intestinal obstruction in adults.
A 49-year-old patient was admitted to the emergency department with the clinical signs suspect of small bowel obstruction. Biochemically no evidence for ischemia did exist as the lactate levels were normal. Inflammatory changes with a high level of CRP did occur. A plain abdominal X ray showed an intestinal obstruction. Additionally a computed tomography was done to detect the underlying cause, revealing a whirl sign, very suggestive for a diagnosis of midgutvolvulus. Peroperatively the radiographic suspicion was confirmed and a concomitant appendicitis was also treated. After disentangling the deformities and the manual detordation of the small intestine appeared normal. The diagnosis of secondary midgutvolvulus based on the presence of adhesions, was put forward.
Midgutvolvulus is a rare cause of a small bowel obstruction in adults. The diagnosis is made by clinical suspicion of an alert doctor, together with CT graphic evidence of a volvulus. The final diagnose however can only be made preoperatively. The therapy of a midgutvolvulus, unlike other forms of small bowel obstruction, always demands a surgical intervention because of the great risk of lifethreatening complications when a conservative approach is followed.