PMC8612868_01
Notable on ultrasound is the appearance of dilated, thickened bowel loops (
A
) and a lack of perfusion on Doppler ultrasound (
B
). Abdominal magnetic resonance imaging demonstrated the torsion of bowel around the mesenteric pedicle (similar to a "whirlpool"-sign (
C
). There was no contrast medium uptake in the affected, thickened bowel segment (
D
).
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Doppler imaging ( Fig. 1A , B ). Differential diagnosis after ultrasound included an intraabdominal inflammatory process leading to an obstruction of small bowel, while a strangulation of bowel, possibly due to intraabdominal adhesions, could not be ruled out. An emergency contrast-enhanced magnetic resonance imaging (MRI) of the abdomen at 1.5 Tesla was performed to confirm the suspected diagnosis of bowel strangulation and evaluate for other intraabdominal and pelvic processes before urgently taking the patient to the operating room ( Fig. 1C , D ).
Contrast-enhanced magnetic resonance angiography demonstrated a slight ventralization of the venous confluence in front of the mesenteric artery (arrow) (
A
). B-mode ultrasound showed a slight clockwise ventralization of the superior mesenteric vein (arrow), which normally lies to the right of the superior mesenteric artery (
B
). Midline laparotomy revealed a 360 degrees-volvulus involving ~115 cm of ileum up to 10 cm proximal of the ileocecal valve with marked intestinal ischemia. The cecum and colon were in their normal anatomical position (not shown) (
C
).
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Correlating MRI and ultrasound, it was noted that the venous confluence, which normally lies to the right of the superior mesenteric artery (SMA), appeared slightly anteriorized on ultrasound and MRI, but there was no diagnostic sign of malrotation or midgut volvulus on ultrasound ( Fig. 2A , B ).  Midline laparotomy revealed a 360 degrees-volvulus of a 115 cm segment of the distal ileum, ending at 10 cm oral to Bauhin's valve ( Fig. 2C ).