Intestinal Malrotation: A Rare Cause of Small Intestinal Obstruction

Abstract

Background. The diagnosis of intestinal malrotation is established by the age of 1 year in most cases, and the condition is seldom seen in adults. In this paper, a patient with small intestinal malrotation-type intraperitoneal hernia who underwent surgery at an older age because of intestinal obstruction is presented. Case. A 73-year-old patient who presented with acute intestinal obstruction underwent surgery as treatment. Distended jejunum and ileum loops surrounded by a peritoneal sac and located between the stomach and transverse colon were determined. The terminal ileum had entered into the transverse mesocolon from the right lower part, resulting in kinking and subsequent segmentary obstruction. The obstruction was relieved, and the small intestines were placed into their normal position in the abdominal cavity. Conclusion. Small intestinal malrotations are rare causes of intestinal obstructions in adults. The appropriate treatment in these patients is placement of the intestines in their normal positions.

Diagnosis and surgical management of congenital intestinal malrotation presenting with midgut volvulus in an adult: high index of suspicion (case report)

“…The rapid increase in length of the intestine and physiologic herniation into the umbilical cord occurs in the fifth week, a 270 o anticlockwise rotation along the SMA axis and the return of hernia back into the abdominal cavity occur in to 10th week, and the location of the caecum in the right lower quadrant are completed in the 12 th week. The variation between the normal rotation and failure of the intestine to rotate due to any malfunction in this process are known as malrotation [ 1 , 4 ]. There are several types of rotational anomalies: a diversity of anatomic configurations, ranging from a not-quite normal intestinal position to complete nonrotation [ 1 ].…”

“…The variation between the normal rotation and failure of the intestine to rotate due to any malfunction in this process are known as malrotation [ 1 , 4 ]. There are several types of rotational anomalies: a diversity of anatomic configurations, ranging from a not-quite normal intestinal position to complete nonrotation [ 1 ]. The most common variations are nonrotation, reverse fixation, and malrotation.…”

“…Congenital Intestinal malrotation is a complex disorder caused by incomplete or abnormal rotation of the intestine during fetal development. Embryological development and anatomical variations were described in 1923 by Dott [ 1 ]. The intestines start to grow in the fourth week of gestation.…”

“…The hernia is reduced in the 10 th week of gestation, with the bowel rotating in an anticlockwise direction, and the caecum settles in its typical right lower quadrant position at 12 th week. Intestinal malrotation is a disorder resulting from the lack of fetal intestinal physiological rotation [ 1 ]. There are often fibrous Ladd's bands that tether the cecum and right colon to the right abdominal wall.…”

“…More than 40% of intestinal malrotations are diagnosed within 1 week after birth and 75-85 % within a year after birth. Although the precise incidence of intestinal malrotation is unknown, it is estimated that it occurs between 0.0001 % and 0.19 % of adults [ 1 - 3 ]. Generally, intestinal malrotation is incidentally found in adults due to its asymptomatic or nonspecific presentation with mild symptoms.…”