The first image demonstrates an abnormally placed DJ flexure with corkscrewing of the bowel indicating volvulus. The second image demonstrates a normally sited DJ flexure to the left of the midline at approimately the level of L1 and at the same level as the duodenal cap.
When a child presents with bilious vomiting, malrotation and volvulus should be suspected. This is a surgical emergency. Although usually less than 3 months old, there is no age limit. Diagnosis is often by fluoroscopy, an abnormally positioned DJ flexure indicates malrotation and a corkscrew appearance indicates volvulus.