Reversed Rotation of the Bowel Causing Acute Intestinal Obstruction*

Davies, Orland; Johansen, Robert; Goldman, Leon

doi:10.1097/00000658-195511000-00016

Cited by 30 publications

(13 citation statements)

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“…When an operation is performed for associated inflammatory disease or other disease concerned with rotational anomalies and it is simply an incidental finding, it is generally wise to treat the immediate problem and leave the anomaly alone. [19][20][21] The nonrotation itself was also left alone in the present case and no problems associated with nonrotation have occurred since the operation.…”

Section: Discussionmentioning

confidence: 49%

Mucinous Cystadenocarcinoma in the Appendix in a Patient with Nonrotation: Report of a Case

et al. 2001

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Mucinous cystadenocarcinoma in the appendix is uncommon. An anomaly in the rotation of the intestine is also uncommon in adults. We herein report a case of mucinous cystadenocarcinoma in the appendix in a patient with nonrotation. To the best of our knowledge, this is the first report of appendiceal carcinoma in a patient with an anomaly of intestinal rotation. A 76-year-old woman was admitted to our hospital with left low abdominal pain. Physical examination revealed tenderness with muscle rigidity in the left lower quadrant. The patient was diagnosed to have intussusception by computed tomography and ultrasonography. An emergency operation showed nonrotation and the top of the appendix situated in the left iliac fossa. An appendectomy was performed because of gangrenous acute appendicitis. However, the cut surface of the appendix showed a mucocele measuring 4 x 4 cm in size. It was diagnosed to be mucinous cystadenocarcinoma histopathologically. A right hemicolectomy with lymph node dissection was performed, and no remaining cancer cells or lymph node metastases were found in the resected specimen pathologically. The patient had an uneventful postoperative course. No signs of recurrence have been observed for 23 months since her last operation.

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Section: Discussionmentioning

confidence: 49%

Mucinous Cystadenocarcinoma in the Appendix in a Patient with Nonrotation: Report of a Case

et al. 2001

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“…2 It is twice as common in women than men. 3 First described in the late 1800s, reversed rotation occurs when the midgut loop erroneously rotates in a clockwise direction. 4 As a result, the duodenum and the transverse colon are reversed in position; the transverse colon lie posterior to the superior mesenteric artery and the duodenum lies anterior.…”

Section: Discussionmentioning

confidence: 99%

Reversed rotation of the midgut in adults – a case report

Balamoun

Mohammad

Hamade

2010

annals

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A 25-year-old man presented via accident and emergency with pain in the left upper quadrant for 4 days. He had constipation for 3 days which progressed to absolute constipation. This was associated with increasing abdominal distension and vomiting of at least 10-15 times a day. He was known to have Gilbert's syndrome, depression and hay fever and had had no previous abdominal surgery. He was a smoker and used to drink alcohol moderately.On examination, he was apyrexial and haemodynamically stable. His abdomen was distended but non-tender, with increased bowel sounds. No hernias and digital rectal examination revealed an empty rectum with no other abnormalities. Full blood count revealed leucocytosis of WCC 14.2 × 10 9 cells/l. Plain abdominal X-ray showed dilated loops of small bowel which were pushed to the right side of the abdomen (Fig. 1). Chest X-ray revealed no abnormalities.He was treated conservatively overnight and re-assessed in the morning when a Gastrograffin follow through was obtained. This showed contrast in the stomach and the duodenum. The pyloric region of the stomach was displaced upward by a significantly enlarged, distended segment of large bowel (Fig. 2). The appearances were likely to represent a caecal volvulus. The rest of the contrast was vomited back. The decision was made to undertake an urgent exploratory laparotomy.Findings at laparotomy were of a caecal volvulus with ischaemia and serosal tears. Reversed rotation of midgut loop, through 90º in a clockwise direction. The transverse colon was seen to cross behind the superior mesenteric vessels (SMVs); the duodenum crosses in front of them; otherwise the disposition of the viscera appeared to be normal. The root of the mesentery of the small intestine (pre-arterial) has Intestinal obstruction is a common surgical emergency. It is often due to adhesions; however, when the patient is young and has a virgin abdomen, we have to consider uncommon causes. We present a rare case of reversed rotation of the midgut as a cause for intestinal obstruction. ON-LINE CASE REPORT

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“…The most common causes of obstruction in these patients include volvulus of the free ileocecal segment, obstruction of the transverse colon by the superior mesenteric vessels, and obstruction at the duodenojejunal junction [2,8]. Alternatively, as is evident by numerous case reports, reverse intestinal rotation can also have a delayed presentation, with recurrent subacute intestinal obstruction or intermittent abdominal pain in adolescents or adults who characteristically have a history of feeding difficulties in infancy [2,5,[7][8][9][10][11][12]. Our patient presented in this delayed fashion.…”

Section: Discussionmentioning

confidence: 99%