Summary about Disease
Midgut volvulus is a life-threatening condition that occurs when the small intestine twists around the superior mesenteric artery, which supplies blood to the intestine. This twisting can obstruct the bowel and cut off blood supply, leading to ischemia, necrosis (tissue death), and potentially bowel perforation. It's a surgical emergency that requires prompt diagnosis and intervention to prevent severe complications. It most commonly occurs in infants, particularly those with malrotation of the intestines (an abnormality present from birth where the intestines do not develop and settle into their proper position).
Symptoms
The symptoms of midgut volvulus vary depending on the age of the individual but commonly include:
Infants: Bilious (green) vomiting, abdominal distension, abdominal pain (manifested as inconsolable crying and drawing up the legs), bloody stools (may occur later as ischemia develops), lethargy, and shock.
Older Children/Adults: Intermittent abdominal pain (often crampy), nausea, vomiting (may or may not be bilious), abdominal distension, and constipation. The symptoms can be more chronic and less acute in older individuals with intermittent volvulus.
Causes
The primary underlying cause of midgut volvulus is intestinal malrotation. Malrotation is a congenital anomaly where the intestines fail to rotate and fix properly during fetal development. This abnormal positioning creates a narrow-based mesentery (the tissue that suspends the intestines), making the intestines prone to twisting. While malrotation is the most common cause, other rare factors can contribute, such as adhesions or bands of tissue that can cause the intestine to twist. Sometimes, the exact cause remains unknown.
Medicine Used
There is no specific medicine to treat midgut volvulus. The primary treatment is surgical. However, certain medications may be used for supportive care:
Intravenous Fluids: To correct dehydration and electrolyte imbalances caused by vomiting and bowel obstruction.
Antibiotics: Broad-spectrum antibiotics are typically administered to prevent or treat infections related to bowel ischemia or perforation.
Pain Medication: Analgesics are used to manage abdominal pain.
Inotropic support: May be used if the patient is in shock due to vascular compromise.
Is Communicable
No, midgut volvulus is not a communicable disease. It is not caused by an infectious agent and cannot be spread from person to person. It is primarily related to a congenital malformation (intestinal malrotation).
Precautions
Since midgut volvulus is often related to congenital malrotation, there are no specific precautions that can prevent its occurrence. However, early recognition of symptoms, especially in infants with known or suspected malrotation, is crucial for timely diagnosis and intervention. Genetic counseling might be considered for families with a history of congenital gastrointestinal anomalies, but it's important to note that malrotation is usually sporadic.
How long does an outbreak last?
Midgut volvulus is not an outbreak-related disease. It's an individual medical emergency. The "outbreak" duration is irrelevant in this context because each case presents as an isolated event.
How is it diagnosed?
Diagnosis typically involves a combination of clinical evaluation and imaging studies:
Clinical Examination: The doctor will assess the patient's symptoms, perform a physical examination (checking for abdominal distension, tenderness, etc.), and review the medical history.
Upper Gastrointestinal (GI) Series: This is the gold standard diagnostic test, especially in infants and children. It involves swallowing barium, a contrast agent, and taking X-rays to visualize the position of the small intestine and duodenum. A "corkscrew" appearance of the duodenum is a classic sign of volvulus.
Abdominal X-ray: May show signs of bowel obstruction but is not specific for volvulus.
Ultrasound: Can be useful as an initial screening tool, particularly in infants, but it is operator-dependent and may not always be conclusive.
CT Scan: Can be used in older children and adults to visualize the bowel and detect signs of volvulus.
Laparotomy/Laparoscopy: In some cases, surgical exploration may be necessary to confirm the diagnosis and correct the volvulus.
Timeline of Symptoms
The timeline of symptoms can vary significantly depending on the degree of volvulus and the age of the patient.
Acute Volvulus (Infants): Symptoms often develop rapidly, within hours. Initially, there may be intermittent crying or irritability. Vomiting (often bilious) typically follows, along with abdominal distension. As the condition progresses, bloody stools may appear, and the infant becomes lethargic and eventually develops signs of shock.
Intermittent Volvulus (Older Children/Adults): Symptoms may be more gradual and intermittent. Episodes of abdominal pain, nausea, and vomiting can occur over days or weeks. The pain may be crampy and resolve spontaneously, only to recur later. Over time, chronic malabsorption and failure to thrive may develop if the volvulus is not diagnosed and treated.
Important Considerations
Prompt Diagnosis and Treatment: Midgut volvulus is a surgical emergency. Delays in diagnosis and treatment can lead to bowel ischemia, necrosis, perforation, sepsis, and death.
Malrotation: The underlying cause is typically malrotation of the intestines. Subsequent surgical management addresses not only the volvulus but also corrects the malrotation to prevent recurrence.
Surgical Intervention: The primary treatment is surgery, typically the Ladd procedure, which involves untwisting the volvulus, dividing Ladd's bands (fibrous bands that contribute to the malrotation), widening the mesentery, and placing the cecum in the left upper quadrant and the small bowel in the right lower quadrant of the abdomen.
Post-Operative Care: Close monitoring of bowel function is crucial after surgery. Nutritional support may be necessary until the bowel recovers.