1) A 7-month-old male presented with a one-month history of bilious vomiting, chronic constipation, and epigastric pain. Imaging showed a spiral appearance of the distal duodenum and proximal jejunum, known as the corkscrew sign, suggestive of intestinal malrotation with midgut volvulus. 2) Intestinal malrotation occurs when the intestines fail to properly rotate during fetal development, leaving them susceptible to twisting, known as volvulus. This is most common in neonates but can occur at any age. 3) The corkscrew sign seen on imaging is pathognomonic for midgut volvulus and results from the distal du

1. APRIL 2022
Teaching File
HRN: 3439683
INDEX NUMBER: 7.74.7.71 SP
Frece Angelo A. Rosalia
1st year Resident

2. SALIENT FEATURES
• MJN
• 7/M
• Makilala, Cotabato
• One-month history of billous vomiting with associated chronic
constipation and epigastric pain
• Skinny. With poor toilet training (BM 2-3/week). Picky-eater.

3. Patient’s image
Anteroposterior Lateral

4. IMPRESSIONS
 CONSIDER INTESTINAL MALROTATION

5. Corkscrew Sign
(of Midgut Volvulus)
• Fluoroscopy findings: spiral appearance of the
distal duodenum and proximal jejunum seen
in midgut volvulus
• Mechanism: The distal duodenum and
proximal jejunum do not cross the midline and
instead pass in an inferior direction. These loops
twist on a shortened small bowel mesentery,
resulting in the characteristic corkscrew
appearance

6. The normal Duodenum on UGI Series
Anteroposterior Lateral
• Located posteriorly, just in front
of the spine (retroperitoneal)
• The duodenum should cross to the left of
midline and then ascend
• The ligament of Treitz (arrow) located at a
similar level as the duodenal bulb (asterisk)
*

7. Clinical Presentation
• Although most common in neonates under 1 month of
age, malrotation with volvulus can occur at any age.
• It should be considered in the differential diagnosis of a
patient with bilious emesis and a proximal obstructive
pattern on radiograph, with a high index of suspicion.
• On occasion, a child may tolerate obstruction from
intermittent volvulus and come to medical attention
because of episodic abdominal pain or symptoms of
malabsorption ie malnutrition.

8. Patient’s image Reference Image

9. REFERENCES
• Brant, W. E., & Helms, C. A. (2012). Fundamentals of diagnostic radiology.
Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Small
Bowel Obstruction. pp 1497-1499.
• Gore, R.M., Levine, M.S. (2014). Textbook of gastrointestinal radiology. 3rd
ed. Elsevier, Philadelphia2008: pp. 863-864
• Radiopaedia©. https://radiopaedia.org/articles/corkscrew-sign-midgut-
volvulusAccessed: 5/24/2022