Midgut Malrotation Causing Intermittent Intestinal Obstruction in a Young Adult

Abstract

Midgut malrotation is a congenital anomaly of intestinal rotation and fixation that is generally seen in neonatal population. Adult cases are rarely reported. Early diagnosis is crucial to avoid life threatening complications. Here, we present an adulthood case of midgut volvulus as a rare cause of acute abdomen.

An adult presentation of midgut volvulus secondary to intestinal malrotation: A case report and literature review

“…The degree the bowel has failed to undergo this physiological rotation can vary and hence there are different classifications of malrotation [ 3 ]. The Stringer classification states there are 3 forms of malrotation; type 1 non-rotation, type 2 duodenal malrotation and type 3 duodenal plus caecal malrotation [ 10 ]. The patient discussed in this case report had type 1 non-rotation malrotation, hence this will be the focus of our discussion.…”

“…The patient discussed in this case report had type 1 non-rotation malrotation, hence this will be the focus of our discussion. Non-rotation malrotation is characterised by malposition of the bowel and malfixation of the mesentery [ 10 ].…”

“…The bowel position associated with normal rotation has the duodenojejunal (DJ) flexure left of the midline at L1 and the terminal ileum located in the right iliac fossa (RIF) [ 11 ]. Bowel position associated with type 1 malrotation however has the small bowel mainly located in right hemiabdomen and large bowel in left hemiabdomen; with an absence of the ligament of Treitz [ 10 ]. This abnormal bowel position results in an ectopic location of the appendix [ 12 ].…”

“…There was 92 adult cases of intestinal malrotation presenting acutely with midgut volvulus described in the published literature [ 4 , 8 , 10 , 12 , 15 , 17 , 18 , 21 , 24 , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] ]. The average age of presentation was 40 years old and there was a 1.7:1 ratio of male to female preponderance [ 4 , 8 , 10 , 12 , 15 , 17 , 18 , 21 , 24 , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] ]. The most common presenting symptoms were severe epigastric or umbilical pain, nausea and vomiting and distension; and all these symptoms were experienced by the patient in this case report [ 4 , 8 , 10 , 12 , 15 , 17 , 18 , 21 , 24 , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] ...…”

“…The average age of presentation was 40 years old and there was a 1.7:1 ratio of male to female preponderance [ 4 , 8 , 10 , 12 , 15 , 17 , 18 , 21 , 24 , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] ]. The most common presenting symptoms were severe epigastric or umbilical pain, nausea and vomiting and distension; and all these symptoms were experienced by the patient in this case report [ 4 , 8 , 10 , 12 , 15 , 17 , 18 , 21 , 24 , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] ]. Diagnosis of the midgut volvulus was predominantly made via CT (67%) but also made via ultrasound (15%) and intra-operatively (18%) [ 4 , 8 , 10 , 12 , 15 , 17 , 18 , 21 , 24 , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] ...…”