Midgut volvulus in an adult

A 19 year old female patient presented complaining of pain in the upper abdomen and vomiting for 10 days. Vomitus was bilious, contained undigested food particles and was non projectile. On examination the patient was mildly dehydrated, afebrile and hemodynamically stable. The abdomen was moderately distended with significant tenderness in the central, epigastric and right hypochondrial regions. There was an ill defined lump palpable in the right upper abdomen. Routine hematological investigations were normal with slight altered renal functions and electrolyte imbalance. Chest and abdominal radiographs were within normal limits. Ultrasonography of the abdomen showed rotation of bowel loops along the axis of superior mesenteric vein and artery in the second and third part of duodenum, with mesenteric lymphadenopathy and mild free fluid in pelvis. Contrast-enhanced computerised tomography (CT) was obtained which demonstrated features of malrotation with swirl appearance of bowel loops starting from the second part of the duodenum