Adult with intestinal malrotation and colocolic intussusception: an unusual combo

Gandhi, Vidhyachandra; Pai, Nitin; Kashiva, Reema; Mane, Dileep

doi:10.1136/bcr-2018-226398

Cited by 5 publications

(7 citation statements)

References 17 publications

(22 reference statements)

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“…Intestinal malrotation is any deviation from the normal embryonic 270° counterclockwise rotation of the midgut and is classified into three types according to the embryonic stage in which the process of rotation was interrupted. There are three types of malrotation: type 1 is non-rotation, type 2 includes only small bowel malrotation and type 3 is defined as malrotation of the duodenum and cecum 2. The patient in our report had type 1 or non-rotational malrotation as evidenced by his rightward duodenum and the leftward position of his colon.…”

Section: Discussionmentioning

confidence: 62%

“…Ultrasound can be used to identify the reversal of normal anatomic positioning of the SMA and superior mesenteric vein (SMV) and the bird-beak appearance of the duodenum indicating an obstruction but carries a high false negative rate of up to 21% 4. Characteristic imaging findings are an anterior and leftward SMV in relation to the SMA (figure 4), a hypoplastic uncinate process of the pancreas and abnormal position of the duodenal-jejunal flexure with small bowel loops on the right and leftward position of the colon 2. Despite the diagnostic imaging findings, acute and complex cases must be confirmed with surgical exploration 4.…”

Section: Discussionmentioning

confidence: 99%

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Surgical management of congenital malrotation presenting in adulthood

Holzemer,

Patel,

Ruiz

et al. 2023

BMJ Case Rep

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Intestinal malrotation is characterised by positional and congenital fixation abnormalities resulting from a failure in embryonic development in the normal 270° rotation around the axis of the superior mesenteric artery. Intestinal malrotation is primarily thought to affect neonates with an incidence of 1 in 500, however, only 1 in 6000 live births are symptomatic, and these usually present within the first month of life in 40% of cases and within the first year in over 5% of cases as an obstructive pathology or volvulus. In adults, however, the incidence has been documented at 0.2%. These patients usually present with postprandial symptoms that are intermittent such as bilious emesis, abdominal pain and malabsorption. Rarely, adults with congenital malrotation may present with acute obstruction due to volvulus, however, less than 100 adult cases are described in the literature. A high index of suspicion is required to identify cases of malrotation in the adult patient which leads to delays in diagnosis and therefore increases in morbidity can be seen.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Surgical management of congenital malrotation presenting in adulthood

Holzemer,

Patel,

Ruiz

et al. 2023

BMJ Case Rep

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“…Type 1 is the most common, found in 2 per 1000 cases of upper gastrointestinal contrast studies 7. Previous studies have reported a lower incidence of type 2 malrotation than the other types, probably because it is unfamiliar to clinicians, includes several subtypes and is less apparent on radiological and intraoperative findings than type 1 or type 3 2 5 8. When found along with colonic cancer, studies have reported either type 1 or type 3 malrotation 9 10…”

Section: Discussionmentioning

confidence: 99%

Anatomical challenge: a rare coexistence of caecal cancer and isolated duodenal malrotation

et al. 2022

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Intestinal malrotation is a congenital anomaly, treated mostly during childhood. A small number of cases are incidentally found in adulthood, during operation for other abdominal diseases, such as colon cancer.Here, we present a case of caecal cancer with isolated duodenal malrotation, a subtype of intestinal malrotation, discovered incidentally during the operation for the cancer. Although the anatomical abnormality made the operation more complicated, laparoscopic resection was safely performed with oncologically adequate lymphadenectomy, owing to intraoperative confirmation of anatomy and careful dissection.

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“…Brereton et al conducted a prospective study where they identified intestinal malrotation-associated intussusceptions in 15 patients, coining the term "Waugh's syndrome" after George E. Waugh [ 7 ]. Although intussusception causes only 5% of cases of intestinal obstruction in adults, about 80 to 90% are secondary to underlying pathologies [ 8 ]. Adults, unlike children and infants present with intussusception, generally have a lead point.…”

Section: Discussionmentioning

confidence: 99%

“…Malignant or benign neoplasms account for around 65% of the adult intussusceptions [ 8 ]. A moveable right colon by a long meso-colon results from an intestinal malrotation.…”

Section: Discussionmentioning

confidence: 99%

Waugh's Syndrome in an Adult Patient: A Case Report and a Review of the Literature

Afasha,

Alabdulwahid,

Dawood

2024

Cureus

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Waugh's syndrome is a rare disease that typically presents as acute-onset intussusception caused by gut malrotation. This disease, while generally reported during infancy or childhood, can also affect adults. This case report describes the rare case of Waugh's syndrome in an adult with cystic fibrosis. The patient, a 19-year-old male, was admitted one week after the onset of pain and distention in the abdomen, with vomiting alternating with constipation. He had visited emergency rooms in the past and was taking symptomatic treatment, but on arrival at our facility, he developed a tonic-colonic convulsion. The evaluation showed respiratory acidosis, severe hyponatremia, and abdominal distension with an empty rectum. The patient was discovered to have colo-colonic intussusception by imaging, and he was admitted into the intensive care unit before exploratory surgery. Surgical findings showed intestinal malrotation with the cecum lying in the left upper quadrant and ilio-colic intussusception extending to the mid-rectum. A distal ileal resection was required for partial reduction, leaving a residual segment needing an ileostomy. Histopathology performed after surgery found a blocked lumen, edema hemorrhage, and necrosis. Following discharge, the patient's recovery was hampered by a high-volume stoma. He had to be readmitted for electrolyte correction and hydration as well as preparation of the normal passage of foods through his system. Later follow-up showed that the output of the stoma had been brought under control, and nutritional status greatly improved. The patient planned to have a stoma reversal after three months. This case emphasizes the need for a multidisciplinary approach to treating Waugh's syndrome in adult patients.

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Adult with intestinal malrotation and colocolic intussusception: an unusual combo

Cited by 5 publications

References 17 publications

Surgical management of congenital malrotation presenting in adulthood

Surgical management of congenital malrotation presenting in adulthood

Anatomical challenge: a rare coexistence of caecal cancer and isolated duodenal malrotation

Waugh's Syndrome in an Adult Patient: A Case Report and a Review of the Literature

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