A Case of Cancer of the Ampulla of Vater Accompanied by Malrotation

Kawahara, Ryuichi; Horiuchi, Hiroyuki; Nogita, Hidefumi; Akashi, Masanori; Mikagi, Kazuhiro; Yoshitomi, Munehiro; Akasu, Gen; Kitasato, Yuhei; Kawashima, Y; Ishikawa, Hiroto; Hisaka, Tohru; Kinoshita, Hisafumi; Tanaka, Hiroyuki

doi:10.2739/kurumemedj.ms61014

Cited by 9 publications

(5 citation statements)

References 11 publications

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“…Malrotations occur in approximately 0.2%–1% of the population ( 4 ). Abnormal gut rotation and fixation to the retroperitoneum/peritoneum lead to malrotation of the intestine, usually including non-rotation, malrotation or incomplete rotation, and inverse rotation, depending on the degree and direction of midgut rotation ( 18 , 19 ). In our case series, all patients had malrotation or incomplete malrotation, which was rotated by 180° and recessed.…”

Section: Discussionmentioning

confidence: 99%

Identification and treatment of intestinal malrotation with midgut volvulus in childhood: a multicenter retrospective study

Yang,

Wang,

Wang

et al. 2024

Front. Pediatr.

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BackgroundIntestinal malrotation is a rare condition, and its delayed diagnosis can lead to fatal consequences. This study aimed to investigate the identification and treatment of malrotation in children.MethodsClinical data, imaging, operative findings, and early postoperative outcomes of 75 children with malrotation were retrospectively analyzed.ResultsThe mean age was 6.18 ± 4.93 days and 51.26 ± 70.13 months in the neonatal group (56 patients) and non-neonatal group (19 patients), respectively. Sixty-seven patients were under the age of 1 year at the time of diagnosis. The occurrence of bilious vomiting and jaundice was significantly higher in the neonatal group (89.29%) than that in the non-neonatal group (37.5%), p < 0.05 and p < 0.01, respectively. The incidence of abnormal ultrasound (US) findings was 97.30% and 100%, respectively, and the sensitivities of the upper gastrointestinal series were 84.21% and 87.5%, respectively. Sixty-six (88%) patients had midgut volvulus, including in utero volvulus (two patients) and irreversible intestinal ischemia (four patients). Most neonates (89.29%) underwent open Ladd's procedure with a shorter operative time (p < 0.01). Reoperation was performed for postoperative complications (four patients) or missed comorbidities (two patients).ConclusionsNon-bilious vomiting was the initial symptom in >10% of neonates and nearly 40% of non-neonates. This highlights the importance for emergency physicians and surgeons to be cautious about ruling out malrotation in patients with non-bilious vomiting. Utilizing US can obviate the need for contrast examinations owing to its higher diagnostic accuracy and rapid diagnosis and can be recommended as a first-line imaging technique. Additionally, open surgery is still an option for neonatal patients.

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Section: Discussionmentioning

confidence: 99%

Identification and treatment of intestinal malrotation with midgut volvulus in childhood: a multicenter retrospective study

Yang,

Wang,

Wang

et al. 2024

Front. Pediatr.

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“…The conventional timeline of the intestinal rotation cycle and its fixation in its normal physiological place commences during the 6th intrauterine week spanning a complete 270 degrees in a counterclockwise manner. When gestational life reaches its 12th week, the ascending colon gets situated in the right quadrant and the descending colon gets situated in the left quadrant whilst the intestines become fixed in their respective location [ 6 ]. Based on the gestational developmental status of fetus, the Stringer Classification was set forth in the literature.…”

Section: Discussionmentioning

confidence: 99%

A distinctive case of congenital midgut malrotation with volvulus in an adolescent female managed by Ladd's procedure - A case report

Laham

Albrijawy

Ahmad

et al. 2022

International Journal of Surgery Case Reports

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Introduction and importance Midgut Malrotation (MM) is a potentially fatal and rare congenital anomaly that results from an incomplete rotation of the bowel 270 degrees around the Superior Mesenteric Axis. Newborns are the most affected age group, nevertheless, adult malrotation can manifest, but in a much rarer incidence rate. Clinical awareness must be present when faced with a surgical abdomen in an adolescent patient because this pathology can have several misleading signs and symptoms which may eclipse the true preoperative diagnosis and masquerade as another, and this could result in implementing a different therapeutic approach. Swift clinical informed judgments must be made and acted upon to limit the morbidity and mortality resultant from this pathology. Case presentation We present the case of a 15-year-old female, who was brought to our Emergency Department (ED) with a 5-day-history of biliary emesis which evolved into obstipation with continuous and excruciating abdominal pain. Computed Tomography (CT) scan indicated gastric and duodenal dilation in addition to a “Whirlpool sign”. Exploratory laparotomy was done, and a Ladd's procedure was performed. Clinical discussion We treated our patient by performing Ladd's procedure and adhesiolysis. Diagnosis is conventionally established pre-/intraoperatively based on radiological imaging and clinical suspicion. Therapeutic methods for this pathology are primarily surgical in nature. Conclusion Midgut Malrotation is a rare entity, thus, it is crucial to further study this type of clinical presentation and keep it in mind to be able to make an accurate diagnosis to reach the optimal outcome for patients who present with acute surgical abdomen.

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“…However, no report on the reconstruction procedure was found. We conducted a review of literature that included Japanese studies by searching the PubMed database, and we found reports on a total of 16 patients with intestinal malrotation who underwent pancreaticoduodenectomy (Table 1) [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. None of the 16 patients developed any complication associated with reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Pancreaticoduodenectomy with malrotation following reoperation due to torsion of efferent loop: a case report

et al. 2020

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Background Malrotation is a congenital anomaly during the development of the embryonic intestine. Although it is generally considered a pediatric surgical condition, it can have significant implications for adult surgery in terms of reconstruction. Case presentation The patient was an 85-year-old man with pancreatic cancer and intestinal malrotation. He underwent pancreaticoduodenectomy with modified Child’s reconstruction. Because the ascending colon and efferent loop twisted easily, we fixed the ascending colon to the abdominal wall. Thereafter, right twist and stenosis of the efferent loop occurred. On the 22nd day after the initial surgery, detorsion and Braun anastomosis were performed for efferent loop fixation. Postoperative oral intake was good, and the patient was discharged from our hospital on the 24th day after the reoperation. Conclusions This is a rare case of pancreaticoduodenectomy with malrotation following reoperation due to a complication after Child’s reconstruction. In similar cases of intestinal malrotation, it is important to consider avoiding coaxial positioning of intestinal parts and an upper abdominal space while selecting a reconstruction method.

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A Case of Cancer of the Ampulla of Vater Accompanied by Malrotation

Cited by 9 publications

References 11 publications

Identification and treatment of intestinal malrotation with midgut volvulus in childhood: a multicenter retrospective study

Identification and treatment of intestinal malrotation with midgut volvulus in childhood: a multicenter retrospective study

A distinctive case of congenital midgut malrotation with volvulus in an adolescent female managed by Ladd's procedure - A case report

Pancreaticoduodenectomy with malrotation following reoperation due to torsion of efferent loop: a case report

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