Presentation of intestinal malrotation and midgut volvulus in adults: Case report & literature review

Abstract

Highlights Intestinal malrotation is uncommon in adulthood and is often missed. Computed tomography scan of the abdomen is the diagnostic tool of choice. Prompt intervention by surgical exploration is crucial for patient survival. Laparoscopy is challenging in diagnosed volvulus or acute bowel obstruction. Correcting asymptomatic malrotation after 20-years-old is not recommended.

Laparoscopic management in an adult patient with intestinal obstruction secondary to congenital midgut malrotation: a case report and review of the literature

“…1 90% of cases are diagnosed in the first year of life. 1,2,8 It is estimated that up to 1 of 200 live births have an asymptomatic rotational anomaly. 3 Adult presentation is uncommon with an estimated incidence of 0.2 to 0.5%.…”

“…3 The classic symptomatology in the newborn is intestinal obstruction, with vomiting of biliary characteristics. 2,4,13 As for the symptomatology in adults, it typically presents with progressive abdominal pain. 4 The chronic and nonspecific symptoms observed in adult malrotation, combined with its low prevalence, result in an incorrect, late diagnosis which increases morbidity and mortality.…”

“…In the case of volvulus, an abrupt cut-off of contrast in the gastrointestinal tract may be seen. 2,5 In adults an abdominal CT scan with oral and intravenous contrast usually gives the diagnosis. The classic finding associated with malrotation on ultrasound and CT is the whirlpool sign, created by collapsed bowel loops surrounding the mesenteric vasculature of the midgut.…”

“…The classic finding associated with malrotation on ultrasound and CT is the whirlpool sign, created by collapsed bowel loops surrounding the mesenteric vasculature of the midgut. 1,2 Neville et al found that about one-fifth of patients had undergone a previous abdominal surgical procedure without a diagnosis of malrotation. 1 Once symptomatic malrotation has been diagnosed, it must be surgically corrected; if there is a confirmed or suspected volvulus, emergency surgery is indicated to prevent complications.…”

“…1,8,13 Consequently the duodenum and cecum unite through Ladd's bands, precipitating midgut volvulus, intestinal obstruction and ischemia. 2 Adult presentation is uncommon with an estimated incidence of 0.2 to 0.5%. 1 The aim of this report was to present the case of a 44 year-old adult with intestinal obstruction due to malrotation with successful laparoscopic management in an emergency setting with literature review.…”