Target sign of intussusception versus whirlpool sign of midgut volvulus

Abstract

We report the case of a 2-month-old boy who presented with emesis and was initially thought to have an intussusception based on ultrasound findings, but was later found to have malrotation with midgut volvulus. He was surgically detorsed before any bowel necrosis occurred, but later developed recurrent volvulus due to a surgical adhesion acting as an anchor point. The aim of this report is to highlight the imaging similarities and differences between intussusception and the more serious midgut volvulus in order to expedite proper care and preserve bowel. Malrotation with midgut volvulus is a pediatric surgical emergency involving twisting of a congenitally shortened mesentery around the superior mesenteric artery, leading to rapid vascular compromise and ischemic necrosis of small bowel. Prompt diagnosis is critical but difficult, as imaging findings in volvulus can appear similar to those in intussusception. Treatment with a Ladd procedure can safely and effectively reduce the volvulus and prevent recurrence.