Midgut Volvulus: Causes, Symptoms, Treatment, Diagnosis, Complications
What Is Midgut Volvulus?
The term Volvulus is given to a medical condition in which there is complete twisting of the loop of intestine around its mesenteric attachment. This twisting can occur at different areas of the gastrointestinal tract like the stomach, the small intestine, cecum, or the sigmoid colon. The term Midgut Volvulus or Midgut Malrotation is a condition in which there is twisting of the midgut around the superior mesenteric artery.
What Are The Causes Of Midgut Volvulus?
In order to know the exact cause of Volvulus, it is necessary to understand the anatomy of the gastrointestinal system. During the development of the fetus at around the fourth week of gestation the gastrointestinal system is in the form of a straight tube which is located centrally in the abdomen. In the remaining period of gestation, the midgut rotates and gets fixed to the posterior abdominal wall. If this normal growth stops at any point in time during the gestational period then there is a risk for development of Volvulus.
What Are The Symptoms Of Midgut Volvulus?
The classic presenting symptom of Midgut Volvulus is bilious vomiting. If a child has persisting vomiting of green or yellow color then it more or less confirms the presence of Midgut Volvulus. These symptoms usually present within the first day of life till the first week when the obstruction is at the maximum. The child may also not be able to tolerate breast milk. If it remains undiagnosed, this advances and at around two months of age there will be bilious as well as non-bilious vomiting occurring at the same frequency. Accompanying symptoms may include failure to thrive, anorexia, constipation, and blood in the stools. Some children may have cyclical vomiting episodes and persistent pain in the abdomen.
How Is Midgut Volvulus Diagnosed?
In order to diagnose Midgut Volvulus the treating physician will perform radiologic studies which will show dilation of both the stomach and the proximal duodenum along with some amount of gas in the case of Midgut Volvulus. This phenomenon is called as "Double Bubble" sign. The study may also show total obstruction of duodenum. In some cases, there will be no gas in the abdomen or ileus with multiple dilated loops clearly seen. This more or less confirms the presence of Midgut Volvulus.
Some other studies that are done for a confirmatory diagnosis of Midgut Volvulus are ultrasound and CT scanning which will clearly reveal malrotation by locating the position of the mesenteric vessels.
What Are Treatments For Midgut Volvulus?
There are basically two forms of treatment for Midgut Volvulus, non surgical and surgical treatment.
Nonsurgical Treatments For Midgut Volvulus: This form of treatment is usually done for those people who are quite old and may be poor candidates for surgery and also may display very minimal symptoms. Observation is done with gastrointestinal decompression through an NG tube with close monitoring looking for any developing signs or symptoms of complications.
Surgical Treatment For Midgut Volvulus: The surgery done for Midgut Volvulus is called as a Ladd's Procedure and is the preferred choice of treatment for Midgut Volvulus. By this method, the Midgut Volvulus is corrected by rotating the small intestine in anticlockwise manner with the cecum located on the left of abdomen and the duodenum down the right paravertebral gutter. In some places, a laparoscopic variation of the Ladd's procedure has also been done as this method leads to minimal scarring and formation of adhesions but for this procedure to be entirely successful, a full view of the bowel is necessary. This procedure is particularly beneficial in children presenting with abdominal symptoms.
What Are The Complications Of Midgut Volvulus?
If Midgut Volvulus is complete and is left untreated for some time then it may lead to intestinal ischemia, mucosal necrosis, and/or sepsis which are quite serious medical complications. If still left untreated it may cause peritonitis and ultimately the patient may succumb to the disease quite quickly. This condition tends to also cause malabsorption along with constipation alternating with diarrhoea. Postprocedure, the main complication is a condition called as Short-Gut Syndrome with its inherent complications like problems with parenteral nutrition with line sepsis along with complications like hepatobiliary dysfunction and growth retardation.
What Are The Ways To Prevent Midgut Volvulus?
As Midgut Volvulus is an exceedingly serious complication in children, a surgery is almost always required for treating it. It is most often done for children with no apparent comorbidities since the recovery is quite fast. This is not case for adults diagnosed with Midgut Volvulus.