An unusual cause of duodenal obstruction in adults

Tack, Greetje J.; Kelckhoven, Bas-Jeroen van; Kuyvenhoven, J.

doi:10.1016/j.ajg.2015.03.002

Cited by 3 publications

(4 citation statements)

References 23 publications

(22 reference statements)

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“…Shortening of the midgut mesentery predisposes to midgut volvulus, and the presence of Ladd's bands can cause small bowel obstruction [4]. Chronic symptoms are more subtle and non‐specific and include intermittent abdominal pain, bloating and food intolerance [5]. This complex and varied clinical picture can result in delayed diagnosis, and patients with malrotation may present to multiple different clinical specialties at various times.…”

Section: Introductionmentioning

confidence: 99%

Adult Presentations of Congenital Midgut Malrotation: A Systematic Review

et al. 2020

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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. Abbreviations CTComputerised tomography MRI Magnetic resonance imaging SMA Superior mesenteric axis

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Section: Introductionmentioning

confidence: 99%

Adult Presentations of Congenital Midgut Malrotation: A Systematic Review

et al. 2020

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“…However, some children may escape this period if they were asymptomatic or only had vague abdominal symptoms which were misinterpreted for another cause [ 5 ]. Diagnosis is rare and unexpected in adults due to presentation with non-specific symptoms such as colicky abdominal pain, bloating, chronic vomiting, malabsorption/inability to gain weight and alternating diarrhoea and constipation [ [1] , [2] , [3] ].…”

Section: Discussionmentioning

confidence: 99%

“…Cases of adult intestinal malrotation are rare but can have devastating consequences if not recognised early. Usually, adults with intestinal malrotation report chronic abdominal symptoms such as intermittent abdominal pain and vomiting, bloating, malabsorption and alternating constipation and diarrhoea [ [1] , [2] , [3] ]. Gold standard diagnosis in adults is usually with cross-sectional imaging with oral and intravenous contrast (computed tomography (CT)), although it is often encountered intra-operatively as well [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Intestinal malrotation in an adult patient with other congenital malformations: A case report

Herle

Halder

2018

International Journal of Surgery Case Reports

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“…4 Adults intestinal mal-rotation often presents with chronic non-specific symptoms which are ignored or confused with other disease presentation includes; intermittent abdominal pain, vomiting, bloating, mal-absorption and alternating constipation and diarrhoea. [5][6][7] Gold standard for diagnosis remains an oral and intravenous contrast CECT with cross-sectional images, but in reality it is often encountered as intraoperative surprise although definitive management includes Ladd's procedure via open or laparoscopic approach. 8…”

Section: Introductionmentioning

confidence: 99%

Midgut malrotation: case series

et al. 2021

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Mal rotation of midgut is associated with other anomalies usually encountered in neonatal period or early childhood. If undetected in childhood it presents in adulthood with small bowel obstruction, repeated appendicitis or chronic abdominal symptoms. CECT abdomen is mandatory for diagnosis though it often presents as surgical surprise on abdominal laparotomy. Hereby, we presented 3 cases where it was undetected till adulthood though CECT was mandatory for definitive diagnosis. Case 1 patient presented with chronic abdominal pain on left abdomen was actually malrotation with appendix lying on left hypochondrium and stenosed fourth part duodenum adding to vomiting off and on. Case 2 patient in adulthood presented with repeated sub-acute intestinal obstruction because of midgut mal-rotation. Relieved after Ladd band was cut and obstructive symptoms relieved. Case 3 patient had inflammed appendix in subhepatic position was cause of chronic pain with para duodenal hernial sac adding to intestinal obstruction with malrotation of midgut.

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An unusual cause of duodenal obstruction in adults

Cited by 3 publications

References 23 publications

Adult Presentations of Congenital Midgut Malrotation: A Systematic Review

Adult Presentations of Congenital Midgut Malrotation: A Systematic Review

Intestinal malrotation in an adult patient with other congenital malformations: A case report

Midgut malrotation: case series

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