A 22-year-old man was admitted to the hospital because of epigastric pain and vomiting. Upper gastrointestinal endoscopy showed a dilatation from the stomach to duodenum. An upper gastrointestinal study revealed stenosis of the jejunum, abnormal position of the duodenojejunal junction, and the proximal jejunal loops to the right of the midline. Barium enema study showed that the ascending colon dislocated to the midline (left-sided colon). Abdominal CT scan revealed a whirl-like pattern, consistent with proximal jejunum encircling the superior mesenteric artery. Enhanced CT scan also showed SMV rotation sign, proximal SMV lied on the right ventral aspect of the SMA. A diagnosis of malrotation of the intestine with volvulus of the midgut was made. At laparotomy, the midgut twisted clockwise by 360°. Ladd's procedure and appendectomy were performed.
Although the midgut volvulus is rare in adults, preoperative diagnosis may be made if the possibility of this disease is kept in mind.