Recurrent acute pancreatitis caused by malrotation of the intestine and effective treatment with laparoscopic Ladd’s procedure

Sasaki, Takashi; Soh, Hideki; Kimura, T.; Hasegawa, Toshimichi; Okada, Akira; Fukuzawa, Masahiro

doi:10.1007/s00383-005-1466-x

Cited by 19 publications

(4 citation statements)

References 15 publications

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“…Associations with the phenomenon of a wandering liver, central nervous system abnormalities and genitourinary malformations have also been reported. Several cases of recurrent pancreatitis have also been reported in patients with malrotation [18][19][20]. In our study this was reported [18].…”

Section: Discussionsupporting

confidence: 78%

Adult Presentations of Congenital Midgut Malrotation: A Systematic Review

et al. 2020

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Background Adult midgut malrotation is a rare cause of an acute abdomen requiring urgent intervention. It may also present in the non-acute setting with chronic, non-specific symptoms. The objective of this study is to identify the clinical features, appropriate investigations and current surgical management associated with adult malrotation. Methods A systematic review was conducted according to PRISMA guidelines, identifying confirmed cases of adult malrotation. Patient demographics, clinical features, investigation findings and operative details were analysed. Results Forty-five reports met the inclusion criteria, totalling 194 cases. Mean age was 38.9 years (n = 92), and 52.3% were male (n = 130). The commonest presenting complaints were abdominal pain (76.8%), vomiting (35.1%) and food intolerance (21.6%). At least one chronic symptom was reported in 87.6% and included intermittent abdominal pain (41.2%), vomiting (12.4%) and obstipation (11.9%). Computerised tomography scanning was the most frequent imaging modality (81.4%), with a sensitivity of 97.5%. The whirlpool sign was observed in 30.9%; abnormalities of the superior mesenteric axis were the commonest finding (58.0%). Ladd's procedure was the most common surgical intervention (74.5%). There was no significant difference in resolution rates between emergency and elective procedures (p = 0.46), but length of stay was significantly shorter for elective cases. (p = 0.009). There was no significant difference in risk of mortality, or symptom resolution, between operative and conservative management (p = 0.14 and p = 0.44, respectively). Conclusion Malrotation in the adult manifests with chronic symptoms and should be considered as a differential diagnosis in patients with abdominal pain, vomiting and food intolerance. Abbreviations CTComputerised tomography MRI Magnetic resonance imaging SMA Superior mesenteric axis

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Section: Discussionsupporting

confidence: 78%

Adult Presentations of Congenital Midgut Malrotation: A Systematic Review

et al. 2020

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“…Among them are humoral proteins circulating in the plasma, endocytic receptors expressed on the cell surface and signalling receptors that can be expressed either on the cell surface or intracellularly [13]. The pro‐inflammatory cytokines such as interleukin‐1 (IL‐1), interleukin‐6 (IL‐6) or TNF‐α have been known to contribute to a variety of inflammatory condition such as ischaemic tolerance [14], rheumatoid arthritis [15], nephritis [16] and liver diseases [17]. Nitric oxide generated through inducible NO synthase (iNOS) enzymatic activity has been found to be participating in various immune and inflammatory reactions.…”

Section: Resultsmentioning

confidence: 99%

In Silico Exploration of Anti‐Inflammatory Activity of Natural Coumarinolignoids

et al. 2011

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Natural coumarinolignoids isolated from the seeds of Cleome viscosa consist of a racemic mixture of cleomiscosins A, B and C. To screen out potential lead, anti-inflammatory activity of the isolated compounds was evaluated through molecular docking and QSAR studies by using reported in vivo activity of Swiss albino mice. Based on docking binding affinity, a possible mechanism of action has been hypothesized which constitute toll-like receptors (TLR-4), cluster of differentiation molecules (CDs), iNOS, COX-2 and STAT-6 proteins. It was very interesting to find that the 3D topology of the active site of COX-2 from the docking was in good agreement with QSAR model and in silico ADME/T parameters. A forward feed multiple linear regression model was developed with r(2) = 0.92 and rCV(2) = 0.87. This study showed that chemical descriptors, for example dipole vector-X, dipole vector-Y, steric energy, LUMO energy, size of smallest ring, size of largest ring and carboxyl group count, correlate reasonably well with experimental in vivo activity (logLD(50) ). QSAR study indicates that dipole vector-Y and carboxyl group count have negative correlation with activity. Cleomiscosins also showed compliance with 95% of in silico ADME/T properties of available drugs, e.g. serum protein binding, blood-brain barrier, CNS activity, HERG K+ channel activity, apparent Caco-2 permeability, apparent MDCK permeability, skin permeability and human oral absorption in GI. Besides, toxicity screening study suggests that cleomiscosin molecules possess no toxicity risk parameters. This study offer useful references for understanding and molecular design of inhibitors with improved anti-inflammatory activity.

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“…10,11 Another well described presentation is mal-absorption pattern associated with diarrhea, nutritional deficiencies and failure to thrive caused by bowel lymphedema resulting from lymphatic obstruction due to chronic volvulus resulting in loss of proteins from bowel lumen. 8,12,13,10 It is important to note that although many patients diagnosed as having malrotation beyond the neonatal period may be asymptomatic, they can still present with intestinal obstruction with or without strangulation at any age. 14,15 High morbidity is associated with both acute and chronic volvulus, thus surgical correction of documented malrotation is the treatment of choice.…”

Section: Discussionmentioning

confidence: 99%

Malrotation presenting beyond infancy: a clinical study

et al. 2018

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Background: Intestinal malrotation is a congenital anomaly that results from abnormal or incomplete rotation and fixation of midgut during embryonic development. This study was done at Niloufer Hospital and Institute for Women and Child Health, Hyderabad with an aim of evaluating the clinical presentation, diagnosis, management and outcome of malrotation presenting beyond 1 year of lifeMethods: Overall 50 cases of malrotation presented to the department of pediatric surgery over a period of 2 year (April 2015 to April 2017). 12 patients of these 50 (12/50) whose age was above 1 year i.e. who were beyond infancy were studied in this studyResults: Out of the 12 patients, 6 were female and 6 were male. Age of patients ranged from 15 months to 13 years. Younger patients below 2 years commonly presented with typical symptoms of bilious vomiting and patients above 2 years of age presented with more varied and vague symptoms. 1/12 of patients presented with a poor general condition and succumbed during the course of treatmentConclusion: Small intestinal obstruction due to malrotation is relatively common in neonatal period. Malrotation beyond infancy is an uncommon diagnosis. Malrotation in grown up children usually is not suspected due to varied symptoms. High index of suspicion is needed as early intervention and treatment in the form of Ladds procedure can prevent any catastrophic events like volvulus and bowel ischemia.

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Recurrent acute pancreatitis caused by malrotation of the intestine and effective treatment with laparoscopic Ladd’s procedure

Cited by 19 publications

References 15 publications

Adult Presentations of Congenital Midgut Malrotation: A Systematic Review

Adult Presentations of Congenital Midgut Malrotation: A Systematic Review

In Silico Exploration of Anti‐Inflammatory Activity of Natural Coumarinolignoids

Malrotation presenting beyond infancy: a clinical study

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