Clinical Review of 10 Cases of Midgut Volvulus

ABSTRACT

PURPOSE: The aims of this study were to review the clinical characteristics of midgut volvulus and recognize the importance of the early diagnosis and treatment of midgut volvulus. METHODS: The medical records of 10 patients with midgut volvulus, diagnosed at the Dankook University Hospital, between May 1995 and May 2001, were retrospectively reviewed. RESULTS: There were 6 male and 4 female subjects. 80% of the patients were younger than 1 month old. The most common symptom was bilious vomiting. A simple abdominal X-ray was performed in 8 cases, with five of these 8 showing positive findings, such as a gasless abdomen or stomach dilatation. Ultrasonography was performed in all 10 cases. The sensitivity of the ultrasonography was 70%. UGI series was performed in 9 cases, and showed 100% sensitivity. Eight patients underwent surgical treatment. Seven infants in the early-diagnosis group had a Ladd operation performed, but only one patient whose diagnosis was delayed underwent a small bowel resection. The 7 patients that had undergone a Ladd operation showed good results after surgery. However, the one whose diagnosis had been delayed developed severe complications and mortality. CONCLUSION: The early diagnosis and adequate intervention for midgut volvulus can prevent life threatening complications. If the ultrasonographic findings are uncertain, especially when the midgut volvulus is untwisted after attack, UGI series or a barium enema should be performed to confirm the diagnosis.