Laparoscopic Management of Intestinal Malrotation With Cocoon Deformity: A Case Report

Abstract

Intestinal malrotation is diagnosed and treated mostly in infancy and childhood, but it is rarely encountered in adults. Here, we present a case of adult intestinal malrotation with cocoon deformity that was managed by a laparoscopic procedure. A 71-year-old man presented with intermittent abdominal pain, nausea, and vomiting. Preoperative findings from abdominal computed tomography, upper gastrointestinal contrast imaging, and enema examination showed intestinal malrotation without volvulus. Diagnostic laparoscopy revealed nonrotation of the midgut, and most of the small bowels were contained in a large peritoneal sac without strangulation. With a definitive diagnosis of intestinal malrotation with cocoon deformity, further laparoscopic repair was performed by widely opening the peritoneal sac, and widening the base of the mesenteric pedicle to prevent future volvulus. There were no postoperative complications. The laparoscopic approach for intestinal malrotation with cocoon deformity can be a safe and useful technique. With the advantage of its minimal invasiveness, it can be an alternative to laparotomy.