Midgut clockwise whirlpool : A case report and review of Gray scale and Color Doppler ultrasonographic findings

Abstract

Midgut volvulus is a cause of acute abdomen in neonates and infants. Learning to recognize the US ?ndings of midgut volvulus is imperative, and it should always be considered in the differential diagnosis of abdominal pain in the pediatric population. For the neonate with the classic appearance of a whirlpool sign, additional imaging investigation is often unnecessary, and the surgeon should be alerted to plan for emergency surgery. Until now, the diagnosis of this condition has relied on upper gastrointestinal barium studies. We describe a case of midgut volvulus diagnosed on ultrasound after observing the whirlpool sign. This sign corresponds to a clockwise wrapping of the superior mesenteric vein and the mesentery around the superior mesenteric artery. Using ultrasound as an investigation modality when suspecting midgut volvulus in neonates and infants is also emphasized. Also, the advantages of US for this age group are apparent, since it can be performed at the bedside in intensive care units and lacks the adverse effects of ionizing radiation.