Simultaneous occurrence of malrotation volvulus and intussusception in an infant

Abstract

A 59-year-old lady presented with malaise, abdominal pain and a low grade pyrexia. After investigation, polymyalgia rheumatica was dmgnosed and she was treated with steroids.However, her condition deteriorated and at diagnostic laparotom a lower pole tumour of the right kidney was found. After conlrming normal function and anatomy of the left kidney by an on-table intravenous pyelogram, she had a right nephrectomy. The renal vein was not involved and the regional lymph nodes were normal. Histology showed a moderately well-differentiated clear cell adenocarcinoma of the kidne After 3 years of excellent health she presented with painress haematuria. Cytoscopy was normal but an IVP and a left retrograde pyelogram showed a filling defect in the mid-ureter, with proximal dilatation of the renal pelvis and calyces (Fig. 1).The left ureter was explored and a soft 2-cm swelling was found in the mid-ureter. She had a wedge resection of the ureter, including the twnour with its pedicle. Histology of the lesion showed secondary adenocarcinoma of the kidney. Later, angiography of her remaining left kidney showed a small tumour at the upper pole and a separate smaller one on the medial aspect.The left kidney was explored and these two well-demarcated and almost encapsulated tumours were excised locally. The renal vein and the para-aortic nodes felt normal. Histology of each tumour showed primary clear cell adenocarcinoma.The patient made an excellent recovery and at 1 year followup remains in good health with no residual symptoms or evidence of recurrence.

Association of midgut malrotation with intussusception

“…One of our patients was a neonate.In one of the patients, volvulus of the midgut occurred simultaneously with intussusception. This rare occurrence had been reported previous by others 2,[8][9][10] . Air-enema reduction of intussuception is widely practiced in other centres.…”

Complex presentation of intussusception in childhood

“…The second case report is similar to our case, describing volvulus of an ileoileal intussusception in a 7-year-old boy without a pathological leadpoint [3]. The next five reported cases [4][5][6][7] involved younger children, ranging from 14 weeks old to an 18-month-old who had intestinal malrotation. In each case, the ileocolic intussusception occurred distal to the midgut volvulus.…”

“…Breckon and Hadley [7] have also recently described six of 12 patients treated at their hospital over a 4-month period as having Waugh's syndrome, one of whom had midgut volvulus and intussusception. Ornstein and Lund [4], in their case report of an infant with intestinal malrotation, proposed that the midgut volvulus led to an increase in intestinal peristalsis that then precipitated the intussusception. However, Burke and Fitzgerald [5] suggested that in their infant, the ileocolic intussusception occurred first.…”

Simultaneous intussusception and sigmoid volvulus in a child

“…A case of ileocecal intussusception presumably secondary to a small bowel volvulus has been reported in a ten month old infant [3]. This was a midgut volvulus associated with malrotation and peritoneal bands.…”