Reverse rotation of gut with small bowel volvulus
Keywords:
Midgut malrotation, Acute abdomen, Ladd’s bands, LaparotomyAbstract
Malrotation of the midgut is generally regarded as paediatric pathology and is rare in adults leading to delay in the diagnosis and management. High suspicion is therefore required in patients with abdominal symptoms. We present a case of a 25-year old female who presented with an acute abdomen with preoperative computed tomography scan and operative findings confirming midgut malrotation. The duodenum, small bowel, caecum and appendix were not located in their anatomical site, with the presence of Ladd’s bands and intestinal volvulus. Emergency laparotomy was done with patient having an uneventful postoperative recovery. Review on malrotation and volvulus is being presented to highlight its rarity and the controversies in its management.
Metrics
References
Torres AM, Ziegler MM. Malrotation of the intestine. World J Surg. 1993;17:326-31.
Matzke GM, Moir CR, Dozois EJ. Laparoscopic Ladd procedure for adult malrotation of the midgut with cocoon deformity: report of a case. J Laparoendosc Adv Surg Tech A. 2003;13:327-9.
3. Von Flue M, Herzog U, Ackermann C, Tondelli P, Harder F. Acute and chronic presentation of intestinal nonrotation in adult. Dis Colon Rectum. 1994;37:192-8.
Wang C, Welch C. Anomalies of intestinal rotation in adolescents and adults. Surgery. 1963;54:839-55.
Frazer JE, Robbins RH. On the factors concerned in causing rotation of the intestine in man. J Anat Physiol. 1915;50:74-110.
Dott NM. Anomalies of intestinal rotation: their embryology and surgical aspects with report of five cases. Br J Surg. 1923;11:251.
Ladd WE. Surgical diseases of the alimentary tract in infants. N Engl J Med. 1936;215:705-8.
Tscherning E. An unusual case of intussusception in childhood. Nord Med Ark. 1883;15:1, Cited by Black CE. Tr West S.A. 1915: 24-87.
Hunter JI. A Mesenteric cyst of jejunal origin complicated by retrojejunal position of the transverse colon. Br Med J. 1922;ii:800.
Snyder WH Jr, Chaffin L. Embryology and pathology of intestinal tract: presentation of 40 cases of malrotation. Ann Surg. 1954;140:368-79.
Dietz DW, Walsh RM, Grundfest-Broniatowski S, Lavery IC, Fazio VW, Vogt DP. Intestinal malrotation: a rare but important cause of bowel obstruction in adults. Dis Colon Rectum. 2002;45(10):1381-6.
Fu T, Tong WD, He YJ, Wen YY, Luo DL, Liu BH. Surgical management of intestinal malrotation in adults. World J Surg. 2007;31:1797-803.
Matzke GM, Dozois EJ, Larson DW, Moir CR. Surgical management of intestinal malrotation in adults: comparative results for open and laparoscopic Ladd procedures. Surg Endosc. 2005;19:1416-9.
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.
Gamblin TC, Stephens RE, Johnson RK, Rothwell M. Adult malrotation: a case report and review of the literature. Curr Surg. 2003;60(5):517-20.
Pickhardt PJ, Bhalla S. Intestinal malrotation in adolescents and adults: spectrum of clinical and imaging features. Am J Radiol. 2002;179:1429-35.
Kapfer SA, Rappold JF. Intestinal malrotation - not just the paediatric surgeon’s problem. J Am Coll Surg. 2004;199:628-35.
Pacros JP, Sann L, Genin G, Tran-Minh VA, Morin de Finfe CH, Foray P, et al. Ultrasound diagnosis of midgut volvulus: the ‘Whirlpool’ sign. Paediatr Radiol. 1992;22:18-20.
Nichols DM, Li DK. Superior mesenteric vein rotation: a CT sign of midgut malrotation. Am J Roentgenol. 1983;141:707-8.
Fisher JK. Computer tomographic diagnosis of volvulus in intestinal malrotation. Radiology. 1981;140:145-6.
Hsu CY, Chiba Y, Fukui O, Sasaki Y, Miyashita S. Counterclockwise Barberpole sign on prenatal three-dimensional power Doppler sonography in a case of duodenal obstruction without intestinal malrotation. J Clin Ultrasound. 2004 Feb;32(2):86-90.
Choi M, Borenstein SH, Hornberger L, Langer JC. Heterotaxia syndrome: the role of screening for intestinal rotation abnormalities. Arch Dis Child. 2005;90:13-5.
Bax NM, van der Zee DC. Laparoscopic treatment of intestinal malrotation in children. Surg Endosc. 1998;12(11):1314-6.
Kalfa N, Zamfir C, Lopez M, Forgues D, Raux O, Guibal MP, et al. Conditions required for laparoscopic repair of subacute volvulus of the midgut in neonates with intestinal malrotation: 5 cases. Surg Endosc. 2004;18:1815-7.
