Correct answer is: Midgut volvulus

Discussion

Midgut volvulus, often seen in neonates and infants, arises as a complication of bowel malrotation (1) . It typically manifests with proximal small bowel obstruction and bilious vomiting. Prompt treatment is crucial to prevent small bowel ischemia, associated morbidity, and potential mortality (1). Initial plain radiographs may be nonspecific, progressing to signs of bowel obstruction or pneumoperitoneum in untreated cases. Complete obstruction can sometimes present with a double bubble sign (2). Ultrasound can be beneficial for identifying volvulus, characterized by the presence of a clockwise whirlpool sign, abnormal superior mesenteric vessels, and an inverted relationship between the superior mesenteric artery and superior mesenteric vein (2). Immediate resuscitation and surgical intervention are necessary in cases of confirmed or suspected midgut volvulus (1).

Additional Images

Image 1: Abdominal ultrasound images, axial planes showing gastric distension (white arrow)

Image 2: Abdominal ultrasound images, axial planes. There is a clockwise whirlpool sign with wrapping of the superior mesenteric vein around (white arrow) the superior mesenteric artery (empty arrow).

Conclusion

Vomiting in neonates or young infants could signal a midgut volvulus causing obstruction.

Conflicts of Interest

The authors declare no conflict of interest

References

1. Allen RP, Akers DR, Shopfner CE. Midgut Volvulus. Radiology. mai 1960;74(5):784‑9.
2. Midgut Volvulus Imaging: Practice Essentials, Radiography, Computed Tomography. 28 avr 2023 [cité 15 mars 2024]; Disponible sur: https://emedicine.medscape.com/article/411249-overview?form=f