0 Its incidence is 1/60000. It constitutes 6% of intestinal obstructions in newborns.
0 The midgut is the part from just below the place where the bile ducts of the primitive intestine open into the duodenum to the distal 2/3 of the transverse colon, and its circulation is provided by the superior mesenteric artery.
Embryological Types
Non-rotation
Duodenojejunal and cecocolic rings could not even complete their first 90° rotation in the SMA axis.
The colon and cecum are in the left quadrant of the abdomen, and the small intestines are on the right.
There is complete or partial duodenal obstruction. Duodenum is right and straight.
Omphalocele and gastroschisis are common.
Incomplete rotation
It occurs as a result of a pause at the second 90° turn of the rotation.
The cecum is typically just above the duodenum in the epigastric region to the left of the SMA.
The entire colon and terminal ileum are to the left of the SMA, while the duodenum and jejunum are to the right.
It constitutes 70-80% of rotation anomalies.
Others
The cecum remains mobile as a result of inability to complete its descent into the iliac fossa.
There is reverse rotation (clockwise).
There are mesocolic (paraduodenal) hernias.
Additional anomalies; There is also a rotation anomaly in gastroschisis, omphalocele and Bochdalek hernia.
They are most frequently associated with gastrointestinal system anomalies (CVS, CNS, lung, GUS)
Rotation and fixation anomalies can also be seen with heterotaxy (situs ambigus).
Clinical Types
• Acute or chronic volvulus (non-rotation) may develop as a result of first-circuit anomalies.
• Colonic obstruction (incomplete rotation) resulting from acute or chronic duodenal obstruction as a result of second-circuit anomalies or reverse rotation may occur.
• They may present with internal herni or cecum volvulus (incomplete fixation) as a result of third-circuit anomalies.
Acute midgut volvulus (midgut volvulus)
• Symptoms are mainly related to partial duodenal obstruction or midgut volvulus.
• Babies start vomiting bile on the first day or within the first month.
• The baby who has expelled or defecated meconium before does not poop, his stomach swells.
• The intestine is felt as a mass on abdominal palpation.
• Rectal bleeding, hypovolemia and shock develop in the late period. Due to this, the skin colors are pale.
• There is respiratory distress due to abdominal distention or aspiration pneumonia.
• On rectal examination, the rectum is empty or there is bloody stool.
• ADBG has a gasless appearance or signs of distal obstruction. It is used in diagnosis in ultrasound and computed tomography.
• It should be operated as soon as the diagnosis is made; if delayed, it may result in short bowel.
Chronic midgut volvulus
• There is intermittent or partial volvulus.
• Symptoms are more pronounced in older, >2 years old children.
• There is colic-like pain that occurs from time to time, biliary vomiting or diarrhea due to venous and lymphatic obstruction, calorie and protein malnutrition.
• There is weight loss and recurrent chronic gastrointestinal symptoms.
• As soon as the diagnosis is made, it should be operated under elective conditions.
Acute and chronic duodenal obstruction
• It happens when Ladd bands press on the duodenum.
• Ladd bands; It is the mature derivative of the embryonic dorsal mesogastrium and normally connects the cecum and mesocolon to the posterior abdominal wall.
• Biliary vomiting is characteristic.
• There are epigastric distension and peristaltic waves in the epigastrium.
• 50% of cases have midgut volvulus at the same time.
• ADBG has a double bubble mark.