Wang Y, Gu Y, Ma D, Guo WX, Zhang YF. Congenital intestinal malrotation with gastric wall defects causing extensive gut necrosis and short gut syndrome: A case report. World J Clin Cases 2022; 10(9): 2851-2857 [PMID: 35434107 DOI: 10.12998/wjcc.v10.i9.2851]
Corresponding Author of This Article
Yun-Feng Zhang, DPhil, Chief Doctor, Full Professor, Children’s Disease Diagnosis and Treatment Center, The Second Hospital of Jilin University, No. 218 Ziqiang Street, Changchun 130041, Jilin Province, China. zhangyunf@jlu.edu.cn
Research Domain of This Article
Pediatrics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Mar 26, 2022; 10(9): 2851-2857 Published online Mar 26, 2022. doi: 10.12998/wjcc.v10.i9.2851
Congenital intestinal malrotation with gastric wall defects causing extensive gut necrosis and short gut syndrome: A case report
Yuan Wang, Ye Gu, Di Ma, Wan-Xu Guo, Yun-Feng Zhang
Yuan Wang, Di Ma, Wan-Xu Guo, Department of Neonatology, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
Ye Gu, Department of Pediatric Surgery, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
Yun-Feng Zhang, Children’s Disease Diagnosis and Treatment Center, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
Author contributions: Wang Y was the patient’s doctor and contributed to the manuscript drafting; Gu Y is the patient’s surgeon and contributed to the manuscript drafting; Ma D and Guo WX analyzed and interpreted the imaging findings and contributed to the manuscript drafting; Zhang YF is the consultant of the patient and revised and reviewed the manuscript; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist, and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yun-Feng Zhang, DPhil, Chief Doctor, Full Professor, Children’s Disease Diagnosis and Treatment Center, The Second Hospital of Jilin University, No. 218 Ziqiang Street, Changchun 130041, Jilin Province, China. zhangyunf@jlu.edu.cn
Received: September 2, 2021 Peer-review started: September 2, 2021 First decision: November 19, 2021 Revised: November 24, 2021 Accepted: February 12, 2022 Article in press: February 12, 2022 Published online: March 26, 2022 Processing time: 201 Days and 9.9 Hours
Abstract
BACKGROUND
Congenital intestinal malrotation (CIM) is a common malformation in neonates. Early diagnosis and surgical intervention can improve the prognosis. CIM combined with congenital gastric wall defect is a potentially fatal condition. We present a severe case of CIM with gastric wall defect causing extensive gut necrosis and short gut syndrome. After three operations, the neonate survived and subsequently showed normal growth and development during infancy.
CASE SUMMARY
A male neonate (age: 4 d) was hospitalized due to bloody stools and vomiting for 2 d, and abdominal distention for 1 d. Emergent exploratory laparotomy revealed black purplish discoloration of the bowel loops. Bowel alignment was abnormal with congestion and dilatation of the entire intestine, and clockwise mesentery volvulus (720°). The posterior wall of the gastric body near the greater curvature showed a defect in the muscularis layer (approximately 5.5 cm), and a circular perforation (approximately 3 cm diameter) at the center of this defect. Ladd’s procedure was performed and gastric wall defect was repaired. Third operation performed 53 d after birth revealed extensive adherence of small intestine and peritoneum, and adhesion angulated between many small intestinal loops. We performed intestinal adhesiolysis, resection of necrotic intestine, and small bowel anastomosis.
CONCLUSION
This case highlights that prolonged medical treatment may help improve intestinal salvage after surgical removal of necrotic intestines, and improve patient prognosis.
Core Tip: In cases of extensive intestine necrosis, adequate delay in the timing of the second laparotomy can offer more time for medical treatment allowing recovery of intestines and improving treatment outcomes.
