Superior mesenteric venous thrombosis in malrotation with chronic volvulus

Malrotation can be difficult to diagnose after the newborn period because o f intermittent symptoms and vague clinical findings, but malrotation with m idgut volvulus is usually quite striking in its presentation. Early diagnos is and surgical treatment are essential to prevent acute ischemic infarctio n of the bowel, although chronic complications are rare. The authors presen t an unusual case of mesenteric venous thrombosis secondary to chronic midg ut volvulus. A 13-year-old girl presented with an Ii-year history of recurr ent bouts of abdominal pain evaluated at 3 other institutions without a dia gnosis. At the referring hospital, an episode of bilious emesis associated with abdominal pain prompted a computerized tomography scan of the abdomen. This showed a calcified thrombus within the superior mesenteric vein (SMV) . At laparotomy, malrotation with chronic 270 degrees volvulus was found wi th evidence of mesenteric venous hypertension. Segmental occlusion was docu mented on magnetic resonance angiography. SMV thrombosis is an unusual comp lication of malrotation with chronic midgut volvulus. Copyright (C) 2000 by W.B. Saunders Company.