 Abstract | | |
An incomplete obstruction of the duodenum and proximal jejunum associated with malrotation and midgut volvulus shows a typical 'corkscrew or twisted ribbon appearance' on barium meal follow through examination. Barium enema confirms the malrotationwith a high, malplaced, subhepatic caecum. We would like to illustrate this sign with an example. Keywords: Corkscrew, Twisted Ribbon, Enema, obstruction
How to cite this article:
Datta S, Hegde K K. Twisted ribbon sign. Indian J Radiol Imaging 2003;13:35-6 |
six month old baby presented with bilious vomiting, abdominal distension, and constipation. On inspection, visible peristalsis was noted in the upper abdomen from right to left. Plain radiograph of the erect abdomen shows gasless abdomen. Barium meal follow through examination shows that the position of the duodeno-jejunal flexure is low and medially placed. The distal duodenum and proximal jejunum beyond the site of obstruction shows "twisted ribbon or corkscrew appearance" [Figure - 1]. Rest of the jejunum and ileum shows malrotation. On Barium enema examination, the caecum is highly placed and subhepatic in location [Figure - 2].
| Discussion | |  |
Normally, volvulus is prevented by the broad base of the mesentery, which extends from the duodeno-jejunal junction at the ligament of Treitz to the caecum.
In malrotation, the abnormal mesenteric fixation of the gut results in volvulus or twisting around the superior mesenteric vessels which can cause ischemic gangrene of the entire small bowel. US and CT can be used to
diagnose some cases of malrotation with volvulus but absence of the findings cannot be relied on to exclude the diagnosis. Hence, Barium meal follow through and Barium enema forms the mainstay of investigation. [1]
In Type III malrotation, when the duodenum has only ninety degrees of rotation left to complete and the large bowel one-eighty degrees; there is either a complete or an incomplete obstruction due to volvulus. An incomplete obstruction of the midgut caused by volvulus shows a "corkscrew or twisted ribbon appearance" on Barium meal follow through examination. [1][2] The duodenojejunal junction and caecum are malpositioned, often lying in the midline. [3],[4]
This is the most dangerous form of malrotation resulting in volvulus, which is a life-threatening emergency. [5] Bilious vomiting in an otherwise healthy infant is the classic presentation and hence be vigorously investigated with Barium meal follow through and Barium enema examination.
| References | | |
| 1. | Stringer D. Pediatric Small Bowel. In : Freeny P.C., Stevenson G.W., eds. Margulis and Burhenne's Alimentary Tract Radiology, 5th ed. St.Louis : Mosby, 1994 : 1878-1906.  |
| 2. | Teele R.L., Share J.C. Diseases of the Stomach and Duodenum. In : Gore R.M., Levine M.S., Laufer I., eds. Textbook of Gastrointestinal Radiology. 1st ed. Philadelphia : WB Suanders, 1994 : 1443-1462. |
| 3. | Berdon W.E., Baker D.H., Ball S. et al. Midgut rotation and volvulus. Radiology. 1970 ; 96 : 375-383. |
| 4. | Snyder W.H., Chaffin L. Embryology of the intestinal tract : presentation of 10 cases of malrotation. Ann. Surg. 1954 ; 140 : 368. |
| 5. | Rescoria F.J., Shedd F.J., Grosfeld J.L. et al. Anomalies of intestinal rotation in childhood : analysis of 447 cases. Surgery 1990 ; 108 : 710-715. |
Correspondence Address:
S Datta
Dept. of Radiodiagnosis, JJM Medical College, Davangere
India
 Source of Support: None, Conflict of Interest: None  | Check |
Figures
[Figure - 1], [Figure - 2] |
