Midgut volvulus caused by intestinal malrotation; A rare cause of acute abdomen in adults. Case report

Abstract

Highlights Midgut volvulus caused by malrotation. Midgut volvulus as a rare cause of acute abdomen in adulthood. Intestinal malrotation presentation in the adulthood.

Complicated Adult Midgut Malrotation: A Challenge to Diagnose and Treat

“…The midgut migrates back into the peritoneal cavity during the weeks 10 th to 12 th , with the caecocolic and duodenojejunal loops rotating 270 o in a counterclockwise manner with respect to the superior mesenteric vessels; the duodenojejunal junction is anchored at the Treitz ligament behind and to the left of the aforementioned vessels, and the caecum is attached to the right iliac fossa (stage II). The final stage consists of fusion of various parts of the mesentery with the posterior parietal peritoneum (stage III) 1,2,4,5,7 .…”

“…Most severe forms of MGM occur as a product of alterations in the normal embryonic gut development between 10-12 weeks of gestation 5 . MGM has been classified into three major types, according to the stage at which the embryologic error occurs.…”

“…Midgut malrotation (MGM) refers to a wide spectrum of congenital abnormalities occurring as a result of partial or complete failure or arrest of the normal 270 o intestinal rotation and fixation process during embryonary period, which may present within the peritoneal cavity as abnormal position of the intestines, especially the right colon, the small intestine with its mesentery, and even the duodenum [1][2][3][4] . This congenital abnormality is usually an isolated condition with an incidence in general population one for every 200-500 newborns and symptomatic cases occurring in one to 6000 newborns, sometimes it is associated with congenital heart disease or situs or biliary tract anomalies; it is mostly recognized and treated by pediatric surgeons 1,2,5 . In adulthood, MGM is estimated to occur in approximately 0.2%-0.5% 2,5,6 , and is clinically significant in only a small portion of cases.…”

“…This congenital abnormality is usually an isolated condition with an incidence in general population one for every 200-500 newborns and symptomatic cases occurring in one to 6000 newborns, sometimes it is associated with congenital heart disease or situs or biliary tract anomalies; it is mostly recognized and treated by pediatric surgeons 1,2,5 . In adulthood, MGM is estimated to occur in approximately 0.2%-0.5% 2,5,6 , and is clinically significant in only a small portion of cases. The rate of incidence is approximately the same for men and women 7 .…”

Case report of congenital intestinal malrotation in an adult discovered three months status-post appendectomy

“…Intestinal malrotation is a congenital anomaly predominantly diagnosed in the first year of life, with only 0.2–0.5% of cases reported in adolescents and adults [1] . Malrotation is associated with significant morbidity, thus diagnostic criteria, understanding of anatomy, and prompt intervention is imperative for optimizing outcomes [2] .…”