Adult intestinal malrotation: a case report

Nyoman T. Pradiptha; Ketut Wiargitha

doi:10.18203/2320-6012.ijrms20195561

Authors

Nyoman T. Pradiptha Department of Surgery, Medical Faculty of Udayana University, Sanglah Central General Hospital, Denpasar, Bali, Indonesia
Ketut Wiargitha Department of Surgery, Medical Faculty of Udayana University, Sanglah Central General Hospital, Denpasar, Bali, Indonesia

DOI:

https://doi.org/10.18203/2320-6012.ijrms20195561

Keywords:

Generalized peritonitis, Intestinal malrotation, Midgut volvulus

Abstract

Midgut malrotation is an incomplete rotation of the intestine which occurs during foetal development and usually presents in the neonatal period. The bowel is not fixed adequately and is thus held by a precariously narrow-based mesentery. The incidence of malrotation has been estimated at 1 in 6000 live births, it is rare for malrotation to present in adulthood. Author report a 40-year-old man presented to emergency department with generalized abdominal pain. His symptoms began 2 days before admission. The patient really weak and his mental state was somnolence. His abdomen was slightly extended, and intestinal peristalsis was obscure. Abdominal X-rays revealed dilatation of gastric, coiled spring appearance without free air and step ladder pattern. The patient then underwent laparotomy exploration. Upon entering the abdomen, ileum was noted to completely mobilized and founded volvulus segment, a clockwise twisting three times, about 30 cm proximal from ICJ, and soon author released it. The ligament of Treitz misplaced, there was in the right lower quadrant, close by ICJ. Then about 110 cm segment of ileum necrotic, the rest of the small bowel was normal, author found internal hernia in the right lower quadrant and there was Ladd's band. Clinicians should be aware of this serious cause of abdominal pain. The diagnosis of malrotation in adulthood is often delayed. Complete resolution of acute obstruction or chronic abdominal pain is the result of a high index of suspicion for malrotation, appropriate diagnostic studies, and aggressive treatment.

Metrics

Metrics Loading ...

References

Powell DM, Othersen HB, Smith CD. Malrotation of the intestines in children: the effect of age on presentation and therapy. J Pediatr Surg. 1989 Aug 1;24(8):777-80.

Fukuya T, Brown BP, Lu CC. Midgut volvulus as a complication of intestinal malrotation in adults. Diges Dis Sci. 1993 Mar 1;38(3):438-44.

Spigland N, Brandt ML, Yazbeck S. Malrotation presenting beyond the neonatal period. J Pediatr Surg. 1990 Nov 1;25(11):1139-42.

von Flüe M, Herzog U, Ackermann C, Tondelli P, Harder F. Acute and chronic presentation of intestinal nonrotation in adults. Dis Col Rec. 1994 Feb 1;37(2):192-8.

Torres AM, Ziegler MM. Malrotation of the intestine. World J Surg. 1993 May 1;17(3):326-31.

Fischer JE, Bland KI, Callery MP, editors. Mastery of surgery. Lippincott Williams and Wilkins; 2006 Dec 18.

Frantzides CT, Cziperle DJ, Soergel K, Stewart E. Laparoscopic Ladd procedure and cecopexy in the treatment of malrotation beyond the neonatal period. Surg Laparoscopy Endo. 1996 Feb 1;6(1):73-5.

Mazziotti MV, Strasberg SM, Langer JC. Intestinal rotation abnormalities without volvulus: the role of laparoscopy. J Am Coll Surg. 1997 Aug 1;185(2):172-6.

Monty ML, Gohl MC. Midgut Nonrotation in Adults. Am J Surg. 1975;129:319-23.

Ladd WE. Congenital obstruction of the duodenum in children. New Eng J Med. 1932 Feb 11;206(6):277-83.

Brandt ML, Pokorny WJ, McGill CW, Harberg FJ. Late presentations of midgut malrotation in children. Am J Sur. 1985 Dec 1;150(6):767-71.

Spitz L, Orr JD, Harries JT. Obstructive jaundice secondary to chronic midgut volvulus. Arch Dis Child. 1983 May 1;58(5):383-5.

Matzke GM, Dozois EJ, Larson DW, Moir CR. Surgical management of intestinal malrotation in adults: comparative results for open and laparoscopic Ladd procedures. Surg Endo Int Tech. 2005 Oct 1;19(10):1416-9.

Pickhardt PJ, Bhalla S. Intestinal malrotation in adolescents and adults: spectrum of clinical and imaging features. Am J Roentgenol. 2002 Dec;179(6):1429-35.

Berdon WE. The diagnosis of malrotation and volvulus in the older child and adult: a trap for radiologists. Pediatr Radiol. 1995 Mar 1;25(2):101-3.

Maxson RT, Franklin PA, Wagner CW. Malrotation in the older child: surgical management, treatment, and outcome. Am Surg. 1995 Feb;61(2):135-8.

Zissin R, Rathaus V, Oscadchy A, Kots E, Gayer G, Shapiro-Feinberg M. Intestinal malrotation as an incidental finding on CT in adults. Abdominal Imaging. 1999 Nov 1;24(6):550-5.

Nichols DM, Li DK. Superior mesenteric vein rotation: a CT sign of midgut malrotation. Am J Roentgenol. 1983 Oct 1;141(4):707-8.

Schulz LS, Lasher EP, Bill AH. Abnormalities of rotation of the bowl. Am. J. Surg. 1961;101:128-33.