Whirlpool sign in intestinal malrotation and midgut volvulus: a case report

漩渦標誌於腸旋轉不良與中腸扭轉之所見

林隆煌(Lung-Huang Lin)

《輔仁醫學期刊》 19卷3期 (2021/09) Pp. 20-25

https://doi.org/10.3966/181020932021091903003

摘要

Background and purpose: Midgut malrotation and volvulus are rare in infants and difficult to diagnose preoperatively . Ultrasound diagnosis has the advantage of no radiation exposure. Color Doppler documenting the reversal or aberrant the superior mesenteric vein (SMV)/ superior mesenteric artery (SMA) axis is not only predictive but also diagnostic of malrotation of gut. Methods : Admitted a 5-day-old newborn with abdominal distention and bilious emesis. Results : Abdominal sonography demonstrated wrapping of the SMV and bowel loops around the SMA ( ＂whirlpool sign＂). An upper gastrointestinal (UGI) series showed a corkscrew appearance of the duodenum, consistent with malrotation and midgut volvulus. The diagnosis of midgut volvulus and mesenteric malrotation was made. The patient underwent successful midgut reduction surgery smoothly. Conclusion: Ultrasonography has been introduced as an alternative method for the diagnosis of malrotation, with an emphasis on the relationship of the SMV and SMA and the so-called ＂whirlpool sign＂ in cases of volvulus. The sonographic whirlpool sign is a valid and highly sensitive sign for the diagnosis of midgut volvulus secondary to malrotation. The whirlpool sign is valuable for the preoperative diagnosis of mesenteric vessel malrotation and midgut volvulus.

關鍵字

color Doppler ultrasound ； corkscrew sign ； intestinal malrotation ； superior mesenteric artery ； superior mesenteric vein ； whirlpool sign

並列摘要

中腸旋轉不良和腸扭轉很少見於新生兒及嬰兒，術前難以診斷。我們報告了一位5天大的新生兒，因腹脹和膽汁性嘔吐住院，腹部超音波檢查顯示一同心圓狀包塊，因上腸繫膜靜脈（SMV）和上腸繫膜動脈（SMA）關係逆轉，SMV位於SMA的前左，而不是腹側和右，即旋轉不良，彩色杜卜勒（Color Doppler）超音波表現漩渦標誌（Whirlpool sign），即小腸及腸繫膜纏繞著上腸繫膜動脈而成的順時鐘漩渦狀，上消化道（UGI）攝影檢查顯示十二指腸呈開瓶器外觀，與旋轉不良和腸中腸扭轉吻合，確診為先天性腸旋轉不良，患者接受了中腸復位術，術後進食狀況一切良好，未再發生嘔吐，9天後病人順利出院。超音波檢查出現漩渦標誌是診斷繼發於旋轉不良的中腸扭轉是有效且高度敏感的信號，漩渦標誌對於術前診斷先天性旋轉不良是極具價值。

並列關鍵字

先天性旋轉不良 ； 中腸扭轉 ； 開瓶器標誌 ； 上腸繫膜靜脈 ； 上腸繫膜動脈 ； 漩渦標誌