DOI: http://dx.doi.org/10.18203/2349-2902.isj20192361

Malrotation of gut presenting in adolescents and adults at a tertiary care hospital: a prospective study

Shabir Ahmad Mir, Mohd Riyaz Lattoo, Waseem Ahmad Dar, Mumtazdin Wani

Abstract


Background: Although malrotation of gut presenting in adolescents and adults is rare, but exists. Also its presentation is nonspecific.  Hence its diagnosis needs high index of suspicion.

Methods: This prospective study was done in the department of surgery at SMHS hospital (GMC Srinagar) over a period of 5.5 years from July 2012 to December 2017. The patients included all  the adolescent and adult patients who proved  to be the cases of malrotation of gut on intraoperative  visualisation.

Results: During the study period, 14 patients with malrotation of gut (belonging to adolescent and adult age group) were recorded. Age of the patients ranged from 16 to 54 years with an average of 26.21±11.15years. Majority of the patients belonged to adolescent age group. Preoperatively CT (computed tomography) scan was done only in 4 patients, thereby making the diagnosis of malrotation preoperatively in these 4 patients. In all other patients, the diagnosis was made only after laparotomy (for acute abdomen) and intraoperative visualisation. Ladd´s procedure was done successfully in majority of patients with two patients requiring resection of gangrenous small bowl and stoma formation.

Conclusions: Malrotation of gut presenting in adolescents and adults is a rare phenomenon and also the symptoms are similar to several other abdominal pathologies, hence it represents a diagnostic challenge. Hence a high index of suspicion is needed to diagnose this rare entity early without undue delay. Threshold for CT scan should be kept a little low in suspicious cases so as to diagnose and intervene in time.


Keywords


Adolescents and adults, Gangrene, Ladd´s procedure, Malrotation

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References


Sahu SK, Raghuvanshi S, Sinha A, Sachan PK. Adult intestinal malrotation presenting as midgut volvulus: case report. J Surg Arts. 2012;5:18-21.

Kotze PG, Martins JF, Rocha JG, Freitas CD, Steckert JS, Fugita E. Ladd procedure for adult intestinal malrotation: Case report. ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo). 2011;24(1):89-91.

von Flüe M, Herzog U, Ackermann C, Tondelli P, Harder F. Acute and chronic presentation of intestinal nonrotation in adult. Dis Colon Rectum. 1994;37:192-198.

Wang C, Welch C. Anomalies of intestinal rotation in adolescents and adults. Surg. 1963;54:839-55.

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

Emanuwa OF, Ayantunde AA, Davies TW. Midgut malrotation first presenting as acute bowel obstruction in adulthood: a case report and literature review. World J Emergency Surg. 2011;6(1):22.

Araújo URMF, Tawil IIE. Adult intestinal malrotation, case report and literature review. ABCD Arq Bras Cir Dig. 2009;22:240-2.

Krapfer SA, Rappold JF. Intestinal malrotation-not just the pedriatric surgeon´s problem. J Am Coll Surg. 2004;199:628-35.

Von FM, Herzog U, Ackermann C, Tondelli P, Harder F. Acute and chronicpresentation of intestinal nonrotation in Colon adults. Dis Rectum. 1994;37:192-8.

Duran C, Ozturk E, Uraz S, Kocakusak A, Mutlu H, Killi R. Midgut volvulus: value of multidetector computed tomography in diagnosis. Turk J Gastroenterol. 2008;19(3):189-92.

Gamblin TC, Stephens Jr RE, Johnson RK, Rothwell M. Adult malrotation: a case report and review of the literature. Current Surg. 2003;60(5):517-20.

Orzech N, Navarro OM, Langer JC. Is ultrasonography a good screening test for intestinal malrotation?. J Pediatric Surg. 2006;41(5):1005-9.

Applegate KE, Anderson JM, Klatte EC. Intestinal malrotation in children: a problem-solving approach to the upper gastrointestinal series. Radiographics. 2006;26(5):1485-500.

Malek MM, Burd RS. The optimal management of malrotation diagnosed after infancy: a decision analysis. Am J Surg. 2006;191(1):45-51.

Husberg B, Salehi K, Peters T, Gunnarsson U, Michanek M, Nordenskjöld A, et al. Congenital intestinal malrotation in adolescent and adult patients: a 12-year clinical and radiological survey. SpringerPlus. 2016;5(1):245.

Nehra D, Goldstein AM. Intestial malrotation: varied clinical presentation from early infancy through adulthood. Surg. 2011;149(3):386-93.

Raitio A, Green PA, Fawkner-Corbett DW, Wilkinson DJ, Baillie CT. Malrotation: age-related differences in reoperation rate. Eur J Pediatr Surg. 2016;26(01):034-7.

Moldrem AW, Papaconstantinou H, Broker H, Megison S, Jeyarajah DR. Late presentation of intestinal malrotation: an argument for elective repair. World J Surg. 2008;32:1426-31.