What is the surgical treatment for midgut volvulus?

Updated: Dec 19, 2018
  • Author: Denis D Bensard, MD, FACS, FAAP; Chief Editor: Carmen Cuffari, MD  more...
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Answer

If midgut volvulus is present, the entire small intestine along with the transverse colon is delivered out of the abdominal incision, where the volvulus can be reduced. Because the volvulus usually twists in a clockwise direction, reduction is accomplished by twisting in a counterclockwise direction. Complete detorsion usually requires 2-3 twists of the bowel. After the blood supply has been restored by detorsion, the surgeon must make a decision about viability of the involved bowel. The outcome is better when no gangrenous bowel is present or when a small, localized gangrenous segment is present, which can be resected and a primary anastomosis performed.

If multiple areas of questionable viability are present, many surgeons choose to leave the areas and perform a second-look operation in 12-24 hours if the patient is not showing clinical recovery. See the image below.

This patient had malrotation with midgut volvulus. This patient had malrotation with midgut volvulus. The gut is darkened in color because of ischemia.

Grossly necrotic bowel should be resected. Primary anastomosis versus diversion of the fecal stream with a proximal ostomy should be performed at the surgeon’s discretion. Three principles should be used to guide decision making:

  • The highest priority is to preserve the maximum length of intestine required for survival.

  • Questionably viable bowel should not be anastomosed.

  • Resection of the entire small bowel require life-long parenteral nutrition or small bowel transplant. [37]


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