Laparoscopic correction of intestinal malrotation in adult

Abstract

Intestinal malrotation is rare in adults. Patients may present with acute obstruction or chronic abdominal pain. These symptoms are caused by Ladd's bands and narrow mesentery resulting from incomplete gut rotation. Barium, computed tomography (CT) and magnetic resonance imaging (MRI), angiography and sometimes explorative laparotomy are used for diagnosis. Ladd's procedure is the treatment of choice but data about laparoscopic approach in adult is scarce. We report three cases of laparoscopic correction of adult malrotation presenting with chronic abdominal pain. The diagnosis is made by CT/MRI. Laparoscopic Ladd's procedure (release of bands, broadening of mesentery and appendicectomy) was performed via three ports. Procedure time 25-45 min. All patients were discharged on postoperative day 2. At 6 month follow-up, all are symptom free. Laparoscopic Ladd's procedure is an acceptable alternative to the open technique in treating chronic symptoms of intestinal malrotation in adults.

Laparoscopic 'steering wheel' derotation technique for midgut volvulus in children with intestinal malrotation

“…The correction of volvulus sounds simple but laparoscopic surgeons always discuss about an ideal technique of derotation of volvulus due to difficulties encountered. [15161718192021] Palanivelu et al ., described the reduction of volvulus after division of bands but exact manoeuvre is not elucidated. [9] The ‘orbit’ technique has been described where the bowel was devolvulated counterclockwise with the grasper used as a pivot which compels the use of one grasper fixing the mesentery at the level of superior mesenteric artery.…”

Laparoscopic Ladd’s procedure: a case report and review of the literature on patient selection for an appropriate surgical approach

“…In the symptomatic patients, the procedure can also result in the alleviation of chronic gastrointestinal symptoms related to malrotation [ 2–5 ]. Key components of the Ladd’s procedure include detorsion of midgut volvulus if present, division of abnormal Ladd bands running from the caecum to the right upper quadrant to alleviate extrinsic compression, broadening of the mesenteric base to prevent future volvulus, placement of the bowel in a non-rotated position and functional with the duodenum and small bowel on the right side and colon on the left and appendicectomy to avoid future diagnostic dilemma [ 2 , 3 , 6 , 7 ].…”

A case of midgut volvulus related to adult intestinal malrotation found with weight loss after streptococcus infection: A case report and literature review

“…Laparoscopic surgery for intestinal malrotation with midgut volvulus in neonates was reported to be feasible and safe compared with open surgery [ 10 ]. There have been several reports of laparoscopic Ladd's procedure for intestinal malrotation without midgut volvulus in adults [ 11 ]. However, in the case of chronic midgut volvulus with intestinal malrotation, it is difficult to perform Ladd’s procedure laparoscopically because of the high number of adhesions.…”