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Aregawi AB, Geremew TT, Legese AT, Bahru TT. A rare case of adult intestinal malrotation: A case report. Int J Surg Case Rep 2025; 127:110848. [PMID: 39787785 PMCID: PMC11762930 DOI: 10.1016/j.ijscr.2025.110848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Revised: 12/27/2024] [Accepted: 01/04/2025] [Indexed: 01/12/2025] Open
Abstract
INTRODUCTION AND IMPORTANCE Intestinal malrotation is a congenital disorder resulting from the failure of the normal embryologic fetal sequence of bowel rotation and fixation. Adult midgut malrotation is extremely uncommon, with incidence estimates ranging from 0.0001 % to 0.19 %. In adults, there is a slight female predominance. Mid gut volvulus leads to obstruction and warrants surgical intervention. This case is significant because there are few case reports around the world. CASE PRESENTATION An 18-year-old Ethiopian man presented with cramping abdominal pain that worsened over a one-month period. He had been experiencing pain since early childhood, which worsened a year before his presentation. CT scan of the abdomen was consistent with malrotation and was treated surgically. CLINICAL DISCUSSION Diagnosing intestinal malrotation in adults is difficult due to the variety and nonspecificity of the symptoms. Delays in diagnosis may lead to acute complications and poorer operative outcomes. CONCLUSION This case report will raise awareness among physicians about the possibility of this rare condition affecting adults. As a result, when a patient presents with chronic gastrointestinal symptoms, they have a high index of suspicion and inform them that an abdominal CT should be performed in these cases, and surgery is the primary treatment option.
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Affiliation(s)
- Alazar Berhe Aregawi
- Department of Surgery, Hawassa University Comprehensive Specialized Hospital, Hawassa, Sidama, Ethiopia.
| | - Teketel Tadesse Geremew
- Department of Pathology, Hawassa University Comprehensive Specialized Hospital, Hawassa, Sidama, Ethiopia.
| | | | - Teferi Tesfaye Bahru
- Department of Infection Prevention and Patient Safety, Eka Kotebe General Hospital, Addis Ababa, Ethiopia
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Sharma C, Borkar NB, Ashwin C, Sinha C. Delayed Presentation of Malrotation after Infancy: A Systematic Review Based on Clinical Presentations, Associated Anomalies, Diagnosis, and Management. J Indian Assoc Pediatr Surg 2024; 29:417-434. [PMID: 39479428 PMCID: PMC11521231 DOI: 10.4103/jiaps.jiaps_105_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/02/2024] [Accepted: 07/02/2024] [Indexed: 11/02/2024] Open
Abstract
Need and Purpose of Review Approximately 75% of patients with classic malrotation and midgut volvulus present in neonatal age-group; another 15% may present up to one year. In these, the diagnosis is made because of typical presentation. However, there are many cases in which malrotation has been detected after infancy. In-spite of the variable case reports and studies in literature, there is no specific data on the incidence of malrotation after infancy, its presentation and management guidelines. With this systematic review, we aim to coalesce these findings from various individual case reports and studies. Methods Used for Collecting and Analysing Data This systematic review was performed as per the PRISMA (preferred reporting items for systematic review and meta-analyses) guidelines. The authors conducted thorough searches in databases like PubMed/MEDLINE, SCOPUS, Google Scholar and Web of Science for relevant articles. Studies were reviewed for clinical presentation and outcome for malrotation diagnosed beyond infancy. Main Conclusions Clinical presentation of malrotation after infancy can be acute as well as chronic; acute presentation being common under 2 years of age and chronic symptoms present as age increases. Sudden onset of abdominal pain and bilious vomiting are commonest acute symptoms and intermittent episodes of recurring vague abdominal pain associated with vomiting and diarrhoea are the commonest chronic symptoms. The diagnostic modalities vary from UGI Contrast series to USG with colour Doppler and CECT scan. Management is operative open as well as laparoscopic Ladd's procedure is being favoured.
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Affiliation(s)
- Charu Sharma
- Department of Paediatric Surgery, AIIMS, Raipur, Chhattisgarh, India
| | | | - C. Ashwin
- Department of Paediatric Surgery, AIIMS, Raipur, Chhattisgarh, India
| | - Chandrasen Sinha
- Department of Paediatric Surgery, St. George’s University Hospital, London, UK
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Bostancı SA, Öztorun Cİ, Erten EE, Akkaya F, Akbaş İ, Çayhan VS, Abay AN, Demir S, Ertürk A, Azılı MN, Şenel E. Clinical management of intestinal malrotation in different age groups. Pediatr Surg Int 2024; 40:204. [PMID: 39033256 PMCID: PMC11271324 DOI: 10.1007/s00383-024-05796-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE Intestinal malrotation, characterized by abnormal intestinal positioning, can lead to severe complications like volvulus and internal hernias, especially in neonates and children. Our aim was to evaluate the diagnostic methods, treatment results and postoperative follow-up of pediatric patients treated for intestinal malrotation. METHODS This retrospective study reviewed medical records of pediatric patients who underwent surgery for intestinal malrotation between January 2013 and January 2022. Data on demographics, symptoms, diagnostic approaches, surgical interventions, and postoperative outcomes were analyzed. RESULTS The study included 45 patients, with a male predominance (68.8%). Ages ranged from 1 day to 15 years, averaging 1.54 years. Presenting symptoms were acute abdomen (n = 21) and chronic abdominal pain with vomiting (n = 24). Diagnoses were established via physical exams and imaging, including upper gastrointestinal contrast studies and abdominal ultrasonography. All patients received the Ladd procedure, with some requiring necrotic bowel resection due to volvulus. CONCLUSION The diagnosis and management of pediatric intestinal malrotation present significant challenges due to its variable symptoms and potential for life-threatening complications. Early and accurate diagnosis, followed by appropriate surgical management, is crucial. This study emphasizes the importance of diligent postoperative follow-up to identify and mitigate complications, particularly in younger and severely affected patients.
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Affiliation(s)
- Süleyman Arif Bostancı
- Faculty of Medicine, Department of Pediatric Surgery, Ankara Yildirim Beyazit University, Ankara, Turkey.
| | - Can İhsan Öztorun
- Faculty of Medicine, Department of Pediatric Surgery, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Elif Emel Erten
- Department of Pediatric Surgery, Ankara Bilkent City Hospital, Childrens' Hospital, Universiteler Boulvard, 1604. Street, Çankaya, 06800, Ankara, Turkey
| | - Fahri Akkaya
- Department of Pediatric Surgery, Ankara Bilkent City Hospital, Childrens' Hospital, Universiteler Boulvard, 1604. Street, Çankaya, 06800, Ankara, Turkey
| | - İrem Akbaş
- Department of Pediatric Surgery, Ankara Bilkent City Hospital, Childrens' Hospital, Universiteler Boulvard, 1604. Street, Çankaya, 06800, Ankara, Turkey
| | - Vildan Selin Çayhan
- Department of Pediatric Surgery, Ankara Bilkent City Hospital, Childrens' Hospital, Universiteler Boulvard, 1604. Street, Çankaya, 06800, Ankara, Turkey
| | - Aslı Nur Abay
- Department of Pediatric Surgery, Ankara Bilkent City Hospital, Childrens' Hospital, Universiteler Boulvard, 1604. Street, Çankaya, 06800, Ankara, Turkey
| | - Sabri Demir
- Department of Pediatric Surgery, Health Science University, Ankara Bilkent City Hospital, Childrens' Hospital, Ankara, Turkey
| | - Ahmet Ertürk
- Faculty of Medicine, Department of Pediatric Surgery, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Müjdem Nur Azılı
- Faculty of Medicine, Department of Pediatric Surgery, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Emrah Şenel
- Faculty of Medicine, Department of Pediatric Surgery, Ankara Yildirim Beyazit University, Ankara, Turkey
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Patel D, Banks D, Hira B, Ford M, Ambartsumyan L, Rodriguez L. Persistent and newly developed gastrointestinal symptoms after surgery for intestinal malrotation in children: Dysmotility or disorders of gut and brain interaction? J Pediatr Gastroenterol Nutr 2024; 78:827-835. [PMID: 38451033 DOI: 10.1002/jpn3.12178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/26/2024] [Accepted: 02/06/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES Surgery for intestinal malrotation (IM) aims to correct the defect and improve symptoms; however, many have persistent gastrointestinal (GI) symptoms postoperatively. We evaluated the incidence, clinical presentation, and long-term outcomes of children with surgically repaired IM and its possible association with disorders of gut and brain interaction (DGBI). METHODS Multicenter retrospective study was conducted in patients from 0 to 21 years old, who had surgery for IM from 2000 to 2021 across three pediatric tertiary care centers. Data analyzed included demographics, time to diagnosis, idiopathic diagnosis, incidental diagnosis, postoperative follow-up, surgical time, and the need for surgery including bowel detorsion. Outcome variables were the presence of postoperative GI symptoms and DGBIs, and overall resolution of symptoms. We also evaluated the potential association of demographics and other included variables with our outcome variables. RESULTS Ninety-two patients with surgically corrected IM were included, 54% were male, and median age of diagnosis and surgical correction was 4.9 and 7.8 months, respectively. Median follow-up after surgery was 64 months. A total of 77% had postoperative GI symptoms, and notably, 78% of patients without symptoms before surgery (incidental diagnosis) developed GI symptoms postoperatively and 27% of patients met Rome IV criteria for a one or more DGBI. No factors were associated to the presence of postoperative symptoms or DGBIs in multivariate analysis. Female gender was the only factor associated with lack of resolution of symptoms at follow-up. CONCLUSION Pediatric IM is commonly associated with postoperative GI symptoms and DGBI well beyond surgery. An increased awareness about the prevalence of DGBI in these patients may help reach a prompt and accurate diagnosis, and improve their quality of life.
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Affiliation(s)
- Dhiren Patel
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Darnna Banks
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, New Haven Children's Hospital, Yale University, New Haven, Connecticut, USA
| | - Bindi Hira
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Madeline Ford
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lusine Ambartsumyan
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Leonel Rodriguez
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, New Haven Children's Hospital, Yale University, New Haven, Connecticut, USA
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Jia XH, Kong S, Gao XX, Cong BC, Zheng CN. Intestinal malrotation complicated with gastric cancer: A case report. World J Clin Cases 2024; 12:210-216. [PMID: 38292641 PMCID: PMC10824180 DOI: 10.12998/wjcc.v12.i1.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/22/2023] [Accepted: 12/15/2023] [Indexed: 01/02/2024] Open
Abstract
BACKGROUND Intestinal malrotation is a congenital defect of embryonic development caused by various teratogenic factors. In this condition, the intestinal tube, along with the superior mesenteric artery serving as the axis for the counterclockwise movement, is incomplete or abnormally rotated due to incomplete attachment of the mesentery and abnormal intestinal tube position. Such a case is usually asymptomatic and thus difficult to detect. Therefore, similar variant malformations are only found during an operation required for other abdominal diseases. CASE SUMMARY An elderly male patient was admitted to the hospital due to gastric cancer. An abdominal computed tomography (CT) scan with contrast revealed that the ascending and descending colon were parallel on the right side of the abdominal cavity, while the sigmoid colon extended into the right iliac fossa, allowing the diagnosis of congenital midgut malrotation. Following thorough preoperative preparation, the patient underwent laparoscopic radical gastrectomy to treat his gastric cancer. Intraoperatively, an exploration of the abdominal cavity uncovered the absence of the transverse colon. The distal colon at the hepatic flexure, along with the ascending colon, extended into the right iliac fossa, where it continued as the sigmoid colon. As planned, the laparoscopic radical gastrectomy was performed, and the patient was discharged from the hospital 7 d after the surgery. CONCLUSION Asymptomatic intestinal malrotation is best detected by CT, requiring no treatment but possibly interfering with the treatment of other diseases.
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Affiliation(s)
- Xiang-Hao Jia
- School of Clinical Medicine, Weifang Medical University, Weifang 261053, Shandong Province, China
| | - Shuai Kong
- Department of Gastrointestinal Surgery, Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250000, Shandong Province, China
| | - Xin-Xin Gao
- Department of Gastrointestinal Surgery, Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250000, Shandong Province, China
| | - Bi-Cong Cong
- Department of Gastrointestinal Surgery, Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250000, Shandong Province, China
| | - Chun-Ning Zheng
- Department of Gastrointestinal Surgery, Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250000, Shandong Province, China
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Patel D, Halverson C, Jayaraman M, Ambartsumyan L, Rodriguez L. Gastrointestinal Symptoms After Surgery for Intestinal Malrotation. J Pediatr Gastroenterol Nutr 2023; 77:316-318. [PMID: 37256844 DOI: 10.1097/mpg.0000000000003840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Dhiren Patel
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, St Louis, MO
| | | | | | - Lusine Ambartsumyan
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
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Bhartiya A, Maqsood H, Naeem H, Nazar MW. Reversed intestinal malrotation presenting as bowel obstruction in pregnancy: Case report and literature review. Ann Med Surg (Lond) 2022; 82:104570. [PMID: 36268437 PMCID: PMC9577447 DOI: 10.1016/j.amsu.2022.104570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/29/2022] [Accepted: 09/04/2022] [Indexed: 11/01/2022] Open
Abstract
Introduction Case presentation Conclusion
Midgut malrotation is a congenital condition caused by insufficient normal intestinal rotation following physiologic gut herniation. Intestinal obstruction in pregnancy is uncommon, but when unrecognized in a timely fashion, it is associated with significant maternal and fetal mortality. A simple release of constricting bands without antimesenteric transposition seems to be the safest option in this situation.
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Pradnyanita Mustika P, Sukmawati M, Darmajaya IM, Dewi IGASM, Artana IWD, Kardana M, Putra PJ, Ariyanta KD. A Rare Case of Chronic Suppurative Appendicitis in Neonatal Presenting as Intestinal Malrotation. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Neonatal appendicitis (NA) is an extremely rare acute abdomen condition, moreover, if it is a chronic suppurative one. The definite risk factor of NA is barely unknown. The signs and symptoms are often nonspecific and appear after perforation occurs. Most of the cases were found unexpectedly during surgery suspected as other diagnoses. A 7-day-old male neonate presenting lethargic and hypoglycemia since 1
st
day of life. Patient drunk breast milk right after since he was born. Meconium was produced <24 h. On the 3
rd
day of hospitalization, he experienced bilious vomiting and abdominal distension, so nasogastric tube was installed. Physical examination revealed decreased bowel sound. Investigation showed leucocytosis, slightly increased procalcitonin and abdominal X-ray showed that gas distribution lasted until third part of duodenum followed by minimal gas distribution in the distal part of duodenum. The patient was suspected as distal duodenum stenosis or proximal jejunum. Intraoperatively, it was found that there was second part duodenum malrotation and open Ladd’s procedure was done. During Ladd’s procedure, a perforated appendix was also found. The histopathology result revealed that it was a chronic suppurative appendicitis. Patient was discharged in good condition 20 days after surgery. NA is a rare condition with nonspecific signs and symptoms which was usually found accidentally during surgery suspected as other diagnoses.
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Xiong Z, Shen Y, Morelli JN, Li Z, Hu X, Hu D. CT facilitates improved diagnosis of adult intestinal malrotation: a 7-year retrospective study based on 332 cases. Insights Imaging 2021; 12:58. [PMID: 33929625 PMCID: PMC8087751 DOI: 10.1186/s13244-021-00999-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/21/2021] [Indexed: 12/17/2022] Open
Abstract
Objective To classify adult intestinal malrotation by CT. Methods This retrospective study enrolled adults diagnosed with intestinal malrotation who underwent abdominal CT at our institution between June 1, 2013, and August 30, 2020. All patients’ clinical information was recorded. Patients were divided into groups undergoing surgical and conservative management. The duodenum (nonrotation, partial rotation, and malrotation), jejunum, cecum, and the superior mesenteric artery/superior mesenteric vein relationship were reviewed on the CT images of each patient, and classification criteria developed based on the first three items. For each patient, each item was assessed separately by three radiologists. Consensus was required from at least two of them. Results A total of 332 eligible patients (218 men and 114 women; mean age 51.0 ± 15.3 years) were ultimately included and classified into ten types of malrotation. Duodenal partial rotation was present in most (73.2%, 243/332) with only 25% (83/332) demonstrating nonrotation. The jejunum was located in the right abdomen in 98.2% (326/332) of cases, and an ectopic cecum was found in only 12% (40/332, 29 cases with a left cecum, 7 pelvic, and 4 at midline). Asymptomatic patients comprised 56.6% (188/332) of cases, much higher than that in previous studies (17%, n = 82, p < .001), comprised mainly of patients with duodenal partial rotation (80.3%, 151/188). In 91 patients with detailed clinical data available (12 managed surgically and 79 conservatively), a significant difference in malrotation CT categorization was identified (p = .016). Conclusions CT enables greater detection of asymptomatic intestinal malrotation, enabling classification into multiple potentially clinically relevant subtypes. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-021-00999-3.
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Affiliation(s)
- Ziman Xiong
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030, Hubei, China
| | - Yaqi Shen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030, Hubei, China.
| | - John N Morelli
- Department of Radiology, St. John's Medical Center, Tulsa, OK, USA
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030, Hubei, China
| | - Xuemei Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030, Hubei, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030, Hubei, China
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Neville JJ, Gallagher J, Mitra A, Sheth H. Adult Presentations of Congenital Midgut Malrotation: A Systematic Review. World J Surg 2021; 44:1771-1778. [PMID: 32030442 DOI: 10.1007/s00268-020-05403-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Adult midgut malrotation is a rare cause of an acute abdomen requiring urgent intervention. It may also present in the non-acute setting with chronic, non-specific symptoms. The objective of this study is to identify the clinical features, appropriate investigations and current surgical management associated with adult malrotation. METHODS A systematic review was conducted according to PRISMA guidelines, identifying confirmed cases of adult malrotation. Patient demographics, clinical features, investigation findings and operative details were analysed. RESULTS Forty-five reports met the inclusion criteria, totalling 194 cases. Mean age was 38.9 years (n = 92), and 52.3% were male (n = 130). The commonest presenting complaints were abdominal pain (76.8%), vomiting (35.1%) and food intolerance (21.6%). At least one chronic symptom was reported in 87.6% and included intermittent abdominal pain (41.2%), vomiting (12.4%) and obstipation (11.9%). Computerised tomography scanning was the most frequent imaging modality (81.4%), with a sensitivity of 97.5%. The whirlpool sign was observed in 30.9%; abnormalities of the superior mesenteric axis were the commonest finding (58.0%). Ladd's procedure was the most common surgical intervention (74.5%). There was no significant difference in resolution rates between emergency and elective procedures (p = 0.46), but length of stay was significantly shorter for elective cases. (p = 0.009). There was no significant difference in risk of mortality, or symptom resolution, between operative and conservative management (p = 0.14 and p = 0.44, respectively). CONCLUSION Malrotation in the adult manifests with chronic symptoms and should be considered as a differential diagnosis in patients with abdominal pain, vomiting and food intolerance.
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Affiliation(s)
- Jonathan J Neville
- Ealing Hospital, London North West University Healthcare NHS Trust, Uxbridge Road, London, UB1 3HW, UK. .,Imperial College Healthcare NHS Trust, Paddington, London, W2 1NY, UK.
| | - Jack Gallagher
- Ealing Hospital, London North West University Healthcare NHS Trust, Uxbridge Road, London, UB1 3HW, UK.,Imperial College Healthcare NHS Trust, Paddington, London, W2 1NY, UK
| | - Anuja Mitra
- Ealing Hospital, London North West University Healthcare NHS Trust, Uxbridge Road, London, UB1 3HW, UK.,Imperial College Healthcare NHS Trust, Paddington, London, W2 1NY, UK
| | - Hemant Sheth
- Ealing Hospital, London North West University Healthcare NHS Trust, Uxbridge Road, London, UB1 3HW, UK
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Brungardt JG, Liebscher SC, Schropp KP. Malrotation Correction in the Adult Population. World J Surg 2020; 45:141-147. [PMID: 32975648 DOI: 10.1007/s00268-020-05790-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Malrotation is a congenital anomaly most often affecting the pediatric population. The Ladd procedure is the standard treatment for this pathology. Well-studied in the pediatric population, large studies of the demographics and outcomes of patients who reach adulthood are lacking. METHODS An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database (2015-2018) was performed, capturing patients with a post-operative diagnosis of malrotation and who underwent surgical correction with or without appendectomy, excluding those who underwent other major procedures such as colectomy. Baseline demographics and outcomes were compared. The primary outcome was mortality. Secondary outcomes such as length of stay and discharge destination were included. RESULTS Two hundred twenty patients undergoing surgical correction of malrotation were captured, all of which were performed by a general surgeon under general anesthesia. One hundered and nine (49.55%) of these patients also underwent an appendectomy. Most of these patients were female (68.18%). Comorbidities and perioperative variables were clinically similar. Operative time was similar between the two groups (112 ± 86 vs. 98 ± 49 min, p = 0.1385). Thirty-day mortality (1.36%), length of stay (4.79 ± 6.21 days), readmission rate (13.64%), wound infection (2.27%) and discharge destination (95.00% to home) were statistically similar between groups. CONCLUSIONS The data describes demographics and outcomes in adults undergoing Ladd procedures with and without appendectomy. Immediate outcomes may be equivalent regardless of incidental appendectomy. Further work is necessary to describe the population of adults with malrotation reaching adulthood.
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Affiliation(s)
- Joseph G Brungardt
- Department of Surgery, The University of Kansas, 4000 Cambridge, M/S 2005, Kansas City, KS, 66160, USA.
| | - Sean C Liebscher
- Department of Surgery, The University of Kansas, 4000 Cambridge, M/S 2005, Kansas City, KS, 66160, USA
| | - Kurt P Schropp
- Department of Surgery, The University of Kansas, 4000 Cambridge, M/S 2005, Kansas City, KS, 66160, USA
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Ferreira MS, Simões J, Folgado A, Carlos S, Carvalho N, Santos F, Costa PM. Recurrent midgut volvulus in an adult patient - The case for pexy? A case report and review of the literature. Int J Surg Case Rep 2019; 66:91-95. [PMID: 31821981 PMCID: PMC6906706 DOI: 10.1016/j.ijscr.2019.11.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/13/2019] [Accepted: 11/17/2019] [Indexed: 12/25/2022] Open
Abstract
Intestinal malrotation and midgut volvulus in adulthood are rare events. Reports of recurrence among adults are very scarce. The rate of recurrence and optimal surgical management are yet to be determined. Bowel fixation procedures may be considered in Ladd procedures for adult midgut volvulus in order to reduce recurrence. Introduction Intestinal malrotation is a rare condition, with an incidence estimated between 0,2 to 1%. Most cases are diagnosed and treated during childhood. Adult presentations are rare and most adults present with chronic nonspecific complaints. Midgut volvulus is the most feared complication of intestinal malrotation, far more common among the pediatric than the adult population. Presentation in adulthood with a midgut volvulus accounts for a minority of these patients (15%). The Ladd procedure is the standard surgical management of midgut volvulus and intestinal malrotation. Most evidence on the outcomes of the Ladd procedure originates from studies on pediatric population and the recurrence among children who have had a Ladd procedure is low (2–7%). Presentation of case We report an exceedingly rare case of a patient who presented in adulthood with a midgut volvulus and less than two years after undergoing Ladd procedure presented with a recurrence of the midgut volvulus. The recurrent midgut volvulus was successfully treated by a fixation procedure (cecopexy and duodenopexy). Conclusion Reports of midgut volvulus in adult patients are scarce and reports of recurrence even scarcer hence the rate of recurrence among adult patients has yet to be determined. The recurrence rate in some of the available adult series is much higher than the rate reported among children. Should the rate of recurrence among adult patients prove higher, it poses the question of whether the Ladd procedure should be modified to include bowel fixation when performed in adults.
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Affiliation(s)
- Margarida S Ferreira
- Department of General Surgery - Hospital Garcia de Orta, Avenida Torrado da Silva, 2805-267 Almada, Portugal; Faculdade de Medicina da Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal.
| | - Joana Simões
- Department of General Surgery - Hospital Garcia de Orta, Avenida Torrado da Silva, 2805-267 Almada, Portugal
| | - António Folgado
- Department of General Surgery - Hospital Garcia de Orta, Avenida Torrado da Silva, 2805-267 Almada, Portugal; Faculdade de Medicina da Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Sandra Carlos
- Department of General Surgery - Hospital Garcia de Orta, Avenida Torrado da Silva, 2805-267 Almada, Portugal
| | - Nuno Carvalho
- Department of General Surgery - Hospital Garcia de Orta, Avenida Torrado da Silva, 2805-267 Almada, Portugal; Faculdade de Medicina da Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Filipa Santos
- Department of General Surgery - Hospital Garcia de Orta, Avenida Torrado da Silva, 2805-267 Almada, Portugal
| | - Paulo Matos Costa
- Department of General Surgery - Hospital Garcia de Orta, Avenida Torrado da Silva, 2805-267 Almada, Portugal; Faculdade de Medicina da Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
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