What is the whirlpool sign?
The whirlpool sign is found on transverse abdominal sonograms of newborns and young infants. This swirling, whirlpool-like shape is created when the superior mesenteric vein (SMV) and the mesentery wrap around the superior mesenteric artery (SMA) in a clockwise direction (,Fig 1), which indicates midgut volvulus.
How is midgut volvulus diagnosed?
An upper GI series is the preferred diagnostic test for malrotation with midgut volvulus and must be performed, unless a delay in surgical treatment will compromise outcome (as in the case of a moribund child). Sensitivity of upper GI series is 85-95%, with a higher specificity (false positives are rare).
What does swirling of the mesentery mean?
The whirl sign depicts anatomic features that can compromise circulation to the bowel. The sign appears as a twist of bowel wrapping around a single constrictive focus of mesentery that may contain intestinal blood vessels [3, 20].
What causes midgut volvulus?
Intestinal malrotation can make an infant more likely to develop a midgut volvulus and occurs in the first few weeks of life. A midgut volvulus is usually part of a vascular compromise in the intestinal mesentery in intestinal malrotation[2].
What causes the whirlpool sign?
The “whirlpool sign” directly indicates the anatomic alteration caused by midgut volvulus. In midgut volvulus, not only the bowel but also the mesenteric vessels are twisted. The SMV and tributaries wrap around the SMA as a result of the volvulus.
Which pathology presents on ultrasound as a whirlpool sign?
The ‘whirlpool sign’ is recognized in the literature as a pathognomonic sonographic sign of small-intestinal volvulus (secondary to malrotation of the midgut) and is used in the pre- and postnatal diagnosis of this pathology1, 2.
What are Ladd’s bands?
Ladd’s bands, sometimes called bands of Ladd, are fibrous stalks of peritoneal tissue that attach the cecum to the retroperitoneum in the right lower quadrant (RLQ).
How do you test for volvulus?
Flexible sigmoidoscopy.
This test, usually only done for volvulus, looks at the lower part of the GI tract, rectum, and colon. It can be used to diagnose the volvulus.
What is Ladd’s procedure?
The Ladd’s procedure is the standard corrective measure for intestinal malrotation in children and consists of division of peritoneal bands (Ladd’s bands) traversing the posterior abdomen, reduction of volvulus, appendectomy, and functional postioning of the intestine with or without fixation.
How is midgut Malrotation diagnosed?
To confirm a diagnosis of intestinal malrotation, patients have various blood tests and diagnostic imaging studies done. These tests include: Abdominal X-ray – Reveals any intestinal obstruction. Barium swallow upper GI test – Examines the small intestine for abnormalities and to check the position of the jejunum.
How is volvulus diagnosed?
Diagnosis of volvulus will typically require traditional x-rays and imaging, during which time doctors will look for a telltale “coffee bean” shape or “bent inner tube” shape in the bowel. A barium enema may also be performed in order to enhance the imaging of the potential obstruction.
What is Target sign in intussusception?
A target sign is classically defined as a CT image associated with thickening of the intestinal wall in which a lower attenuated middle layer is surrounded on each side by layers of higher attenuation [1]. The diagnosis of a small bowel target sign most commonly correlates with intussusception.
What is Whirlpool ovarian torsion?
Conclusions: A positive whirlpool sign in the twisted vascular pedicle of the ovary is the most definitive sign of ovarian torsion. Absence of blood flow in the twisted pedicle and visualization of the flow in the artery alone are predictive of nonviability of the ovary.
What is the difference between malrotation and volvulus?
Malrotation occurs when the intestine does not make the turns as it should. It occurs equally in boys and girls. However, more boys have symptoms by the first month of life than girls. A volvulus is a problem that can occur after birth as a result of intestinal malrotation.
What is SMA syndrome?
Superior mesenteric artery (SMA) syndrome is a rare condition that involves compression of the third portion of the duodenum which is the upper part of the small intestines just past the stomach.
What are signs of a twisted bowel?
Symptoms
- Crampy abdominal pain that comes and goes.
- Loss of appetite.
- Constipation.
- Vomiting.
- Inability to have a bowel movement or pass gas.
- Swelling of the abdomen.
How do you rule out volvulus?
What is the difference between volvulus and malrotation?
Malrotation causes the parts of the intestine to settle in the wrong part of the abdomen, which can cause them to become blocked or to twist. Intestinal volvulus is a condition in which the bowel becomes twisted, which may be the result of malrotation.
What are signs of intestinal malrotation?
What are the symptoms of malrotation?
- vomiting, often with bile in the vomit, which makes it green in color.
- failure to thrive.
- pain or tenderness in the abdomen.
- bloating of the abdomen.
- bleeding from the rectum or passing bloody stools.
What is Doughnut sign?
The doughnut sign refers to the bone scan pattern whereby there is increased uptake peripherally with a photopenic center. This appearance may be seen in a number of cystic lesions including: aneurysmal bone cyst. giant cell tumor.
What is Pseudokidney sign?
The pseudokidney sign, as seen at ultrasonography (US), is composed of a mass that has a reniform appearance, with a central hyperechoic region surrounded by a hypoechoic region (,Fig 1).
How is ovarian torsion diagnosed?
An ultrasound (usually a transvaginal one) can confirm the diagnosis. “If a patient has severe pelvic pain and is nauseous and I can feel the cyst during a pelvic exam, we will use transvaginal ultrasound to see if the ovary is enlarged, which could indicate torsion,” Dr. Fan explains.
What are the symptoms of a twisted ovarian cyst?
Ovarian torsion.
Cysts that become large can cause the ovary to move. This increases the chance of painful twisting of the ovary (ovarian torsion). If this happens, you might have sudden, severe pelvic pain and nausea and vomiting. Ovarian torsion can also reduce or stop blood flow to the ovary.
What are the signs of intestinal malrotation?
What is the surgery for nutcracker syndrome?
Conclusion: Left renal vein transposition is an efficient surgical treatment for nutcracker syndrome. In some cases however pelvic pain remains following left renal vein transposition.