INTESTINAL MALROTATION IN 35 YEAR OLD WOMEN FROM PESHAWAR, PAKISTAN

Zubair Ahmad Khan; Omer Nasim; Zeinab Hussain; Jamil Ahmad

doi:10.46903/gjms/17.04.2097

INTESTINAL MALROTATION IN 35 YEAR OLD WOMEN FROM PESHAWAR, PAKISTAN

Zubair Ahmad Khan, Omer Nasim, Zeinab Hussain, Jamil Ahmad

Abstract

Thirty five years old women presented to the Accident and Emergency Department with acute onset right upper quadrant abdominal pain with normal vitals. CT images revealed a malrotation causing midgut volvulus and intestinal obstruction. On emergency exploratory laparotomy, the gut loops showed partial ischemia due to a double twist at the root of mesentery and malrotation of the gut along with the caecum which was mobile coming from left iliac fossa and lying in the right iliac fossa. Duodeno-jejunal junction was identified. The coils of the intestine were untwisted and rotation was corrected. The gut color changed back to normal. She was discharged painless after routine post-operative care.

Keywords

Malrotation; Volvulus; Intestinal Obstruction; Mesentery; Duodenum; Small Intestine.

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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(1): 18-21.

Emanuwa OF, Ayantunde AA, Davies TW. Midgut malrotation first presenting as acute bowel obstruction in adulthood: a case report and literature review. World J Emerg Surg 2011 Jul 29; 6(1): 22. https://doi.org/10.1186/1749-7922-6-22

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 2003 Oct 1; 13(5): 327-9. https://doi.org/10.1089/109264203769681736

Torres AM, Ziegler MM. Malrotation of the intestine. W J Surg 1993 May 1; 17(3): 326-31. https://doi.org/10.1007/BF01658699

Fung AT, Konkin DE, Kanji ZS. Malrotation with midgut volvulus in an adult: a case report and review of the literature. J Surg Case Rep 2017 May; 2017(5). https://doi.org/10.1093/jscr/rjx081

Low SF, Ngiu CS, Sridharan R, Lee YL. Case Report: Midgut malrotation with congenital peritoneal band: a rare cause of small bowel obstruction in adulthood. BMJ Case Rep 2014; 2014. https://doi.org/10.1136/bcr-2013-202690

Bernstein SM, Russ PD. Midgut volvulus: a rare cause of acute abdomen in an adult patient. AJR. American J Roentgenol 1998 Sep; 171(3): 639-41. https://doi.org/10.2214/ajr.171.3.9725289

Zengin A, Uçar Bİ, Düzgün ŞA, Bayhan Z, Zeren S, Yaylak F, et al. Adult midgut malrotation presented with acute bowel obstruction and ischemia. Int J Surg Case Rep 2016 Jan 1; 22: 5-7. https://doi.org/10.1016/j.ijscr.2016.03.018

Haak BW, Bodewitz ST, Kuijper CF, de Widt-Levert LM. Intestinal malrotation and volvulus in adult life. Int J Surg Case Rep 2014 Jan 1; 5(5): 259-61. https://doi.org/10.1016/j.ijscr.2014.02.013

Ladd WE. Surgical diseases of the alimentary tract in infants. New England J Med 1936 Oct 15; 215(16): 705-8. https://doi.org/10.1056/NEJM193610152151604

Butterworth WA, Butterworth JW. An adult presentation of midgut volvulus secondary to intestinal malrotation: A case report and literature review. Int J Surg Case Rep 2018; 50: 46-9. https://doi.org/10.1016/j.ijscr.2018.07.007

Araújo, Ubirajara Rutilio Mendes e Ferreira de, El Tawil, Imad Izat. Adult intestinal malrotation, case report and literature review. ABCD: Arq Bras Cir Dig 2009; 22(4): 240-2. https://doi.org/10.1590/S0102-67202009000400013

Wanjari AK, Deshmukh AJ, Tayde PS, Lonkar Y. Midgut malrotation with chronic abdominal pain. North Am J Med Sci 2012 Apr; 4(4): 196-8. https://doi.org/10.4103/1947-2714.94950

Ameh EA, Nmadu PT. Intestinal volvulus: aetiology, morbidity, and mortality in Nigerian children. Pediatr Surg Int 2000; 16 (1-2): 50-2. https://doi.org/10.1007/s003830050013

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 Sep; 19(3): 189-92.

Gamblin TC, Stephens Jr RE, Johnson RK, Rothwell M. Adult malrotation: a case report and review of the literature. Curr Surg 2003; 60(5): 517-20. https://doi.org/10.1016/S0149-7944(03)00030-8

Orzech N, Navarro OM, Langer JC. Is ultrasonography a good screening test for intestinal malrotation? J Pediatr Surg 2006; 41(5): 1005-9. https://doi.org/10.1016/j.jpedsurg.2005.12.070

Applegate KE, Anderson JM, Klatte EC. Intestinal malrotation in children: a problem solving approach to the upper gastrointestinal series. Radiographics 2006 Sep-Oct; 26(5): 1485-500. https://doi.org/10.1148/rg.265055167

Hota PK, Abhishek D, Bhaskar V. Adult midgut malrotation with Ladd's band: a rare case report with review of literatures. Bali Med J 2014; 3(3): 137-42. https://doi.org/10.15562/bmj.v3i3.91

Malek MM, Burd RS. The optimal management of malrotation diagnosed after infancy: a decision analysis. Am J Surg 2006; 191(1): 45-51. https://doi.org/10.1016/j.amjsurg.2005.10.002

Hsu YC, Hsu LS, Huang WS, Weng JC, Chen CW. Short bowel syndrome caused by laparoscopic loop enterostomy of the jejunum in an adult with undiagnosed intestinal malrotation: A case report. Medicine 2018 Oct; 97(40): e12712. https://doi.org/10.1097/MD.0000000000012712

Yanez R, Spitz L. Intestinal malrotation presenting outside the neonatal period. Arch Dis Child 1986; 61(7): 682-5. https://doi.org/10.1136/adc.61.7.682

Li X, Zhang J, Li B, Yi D, Zhang C, Sun N, et al. Diagnosis, treatment and prognosis of small bowel volvulus in adults: A monocentric summary of a rare small intestinal obstruction. PloS One 2017 Apr 20; 12(4): e0175866. https://doi.org/10.1371/journal.pone.0175866

DOI: https://doi.org/10.46903/gjms/17.04.2097