Intestinal Malrotation in a Patient Undergoing Laparoscopic Gastric Bypass

Abstract

Intestinal malrotation is an anomalous disorder resulting from the incomplete rotation and fixation of the midgut during embryonic development. Although most patients present early in life with symptoms of bowel obstruction, others remain asymptomatic throughout their lives. We report the case of a 40-year-old morbidly obese woman with no significant past medical history, found to have intestinal malrotation on initial laparoscopic exploration for gastric bypass.

Re-do Roux-en-Y Gastric Bypass in a Patient with Known Midgut Malrotation

“…4,5,8,9,11 There was one case of small bowel obstruction one week postoperatively that required laparoscopic surgery. 6 No mortality in association with MM and gastric bypass has been reported.…”

“…4 Two patients were converted to open procedure because of difficulty in identifying the anatomy. 5 Two centers reported that the procedure was abandoned when anatomy was found to be abnormal: one patient was found to have MM and the procedure was performed at a later date, 6 and the other patient had situs inversus. 7 Ladd's bands were divided in six patients 5,6,8–10 and/or prophylactic appendicectomy, along with gastric bypass, was performed in six patients.…”

“…5 Two centers reported that the procedure was abandoned when anatomy was found to be abnormal: one patient was found to have MM and the procedure was performed at a later date, 6 and the other patient had situs inversus. 7 Ladd's bands were divided in six patients 5,6,8–10 and/or prophylactic appendicectomy, along with gastric bypass, was performed in six patients. 4,5,8,9,11 There was one case of small bowel obstruction one week postoperatively that required laparoscopic surgery.…”

Midgut Volvulus Following Laparoscopic Gastric Banding—A Rare and Dangerous Situation

“…One (1) patient had a preoperative evaluation, 2 and the other patients were noticed to have a malrotation during a gastric bypass procedure. 3,4 All patients underwent an uneventful Ladd's procedure during the initial operation. The Ladd's procedure may be accomplished laparoscopically with a division of the Ladd bands and a placement of the right colon in the left abdomen, 5 if a malrotation without volvulus is found.…”

Experience with the Duodenal Switch Operation in the Presence of Intestinal Malrotation

“…This may be compounded by the unexpected nature of the problem as testing for IM is not routine in preoperative workup for bariatric surgery. Currently, the English language literature describes five reports of patients with IM undergoing laparoscopic Rouxen-Y gastric bypass [2][3][4][5][6]. We hereby describe our own experience with the Duodenal Switch operation in patients with IM.…”