Zarafshan Shiraz, Delhi
Midgut volvulus is a health disorder in which the intestine twists as a result of malrotation during pregnancy or when the normal embryologic sequence of intestinal development and fixation is disrupted i.e. the gut malrots. While midgut volvulus is a consequence of bowel malrotation and mesenteric malfixation, intrinsic small bowel volvulus is an unique and uncommon condition defined by torsion of the whole small intestine with normal mesenteric fixation.
In an interview with HT Lifestyle, Dr Ameet Mandot, Head-Department of Hepatology and Liver Intensive Care Unit at Global Hospital in Mumbai, revealed, “Acute abdomen caused by midgut volvulus with intestinal malrotation is a rare occurrence, with just a few examples documented in the literature. An abnormality in embryonic development between 10 and 12 weeks of gestation causes intestinal malrotation. The fundamental difference is an abnormal position of the bowel, with the small intestine on the right side of the abdomen and the colon and cecum on the left due to Treitz ligament malposition. Moreover, the ascending colon is held to the abdominal wall by fibrous peritoneal bands known as Ladd bands, causing midgut volvulus and intestinal blockage.”
Talking about how Midgut Volvulus is diagnosed, he shared, “Diagnostic techniques for malrotation and volvulus may include several imaging examinations in addition to a physical exam and medical history (tests that show pictures of the inside of the body). These tests are used to determine whether the intestine is twisted or obstructed. The recommended diagnostic test for malrotation with midgut volvulus is an upper GI series, which must be performed unless a delay in surgical treatment may impair outcome (as in the case of a moribund child). Upper GI series sensitivity is 85-95%, with a greater specificity (false positives are rare).”
He highlighted about Fluoroscopy which is when a diagnosis is suspected, a paediatric upper gastrointestinal contrast scan is the investigation of choice and not only can it detect the volvulus but it can also detect the underlying malrotation in cases when spontaneous reduction has occurred. The health expert emphasised, “Midgut volvulus can occur at any age, although it is most frequent in the first few weeks of birth. The initial sign of volvulus is generally bilious emesis. Babies who arrive with acute bilious vomiting, upper abdominal distension and abdominal soreness coupled with hemodynamic deterioration must be assessed as soon as possible to rule out intestinal malrotation as well as volvulus. Hematochezia can also be seen in babies with volvulus caused by intestinal ischemia. It can potentially lead to circulatory collapse if left untreated. Physical examination findings for advanced illness will include erythema and edoema of the abdomen wall, as well as symptoms of peritonitis indicative of intestinal ischemia.”