Volvulus (Differential Diagnosis as before)

anus_20a_n.jpg: Operative findings in a 3-day-old girl with sudden onset of bilious vomiting, abdominal colics and melaena. The voluminous loops of the intestine are twisted in a clockwise direction at the base of the mesentery. The color of the intestinal loops is slightly blue, but vital. anus_20b_n.jpg: Operative findings in a 5-month-old girl with an analogous history as in anus_20a_n.jpg. The visible intestinal loops are dark-red and black. anus_20a_n.jpg and anus_20b_n.jpg: In both cases the diagnosis is a volvulus of the small intestine. Although often an external compression of the duodenum or a lower situated obstruction dominate the clinical presentation, in case of sudden onset of maelena the possibility of a volvulus of the small intestine must always be considered. anus_20cEn_n.jpg: Stages of normal fetal rotation of the intestine from the 4th to the 12th fetal week. The primitive intestinal loop which lies in the 4th to 5th fetal week in the sagittal plane turns during the following 8 months three times by 90 in a counter-clockwise direction, and adhesions of the intestine occur afterward to the posterior wall of the peritoneal cavity. If this rotation is partially absent or occurs in the wrong direction, or if the adhesions are missing, disorders of rotation or fixation are present, such as nonrotation, incomplete rotation, or incomplete fixation. In these cases the root of the mesentery is very small which may lead to a volvulus of the intestine. It occurs mainly in the neonate or in the first year of life. The disorders of rotation are one of the main causes of volvulus.