Late Presentation of Intestinal Malrotation: An Argument for Elective Repair

Abstract

This large case series of intestinal malrotation in the nonpediatric age group suggests that Ladd's procedure can be performed very safely. Moreover, the results suggest that patients with known malrotation should have Ladd's procedure performed electively rather than urgently.

Intestinal malrotation and volvulus in adult life

“…14 Many authors are therefore now advocating early surgical treatment for asymptomatic patients who are by coincidence diagnosed with any sort of malrotation. 3,4,6,15,16 Intervention comes in the form of a surgical Ladd's procedure. 8 This procedure consists of 4 parts: counterclockwise detorsion of the midgut volvulus if present; division of Ladd's bands overlying the duodenum thereby relieving the cause of the intermittent obstruction; widening of the narrowed root of the small bowel mesentery by mobilizing the duodenum; and division of the adhesions around the SMA to prevent further volvulus.…”

An unusual cause of duodenal obstruction in adults

“…Distinctive features of midgut malrotation are primarily established by radiological investigations. Upper gastrointestinal contrast series remain the reference to diagnosis in infants given an accuracy of 80% and the increased radiation risk associated with computed tomography [13,14], whereas findings on a plain radiography are often non-specific [15]. As demonstrated in our patient, in adults however computed tomography is very valuable in diagnosis with a diagnostic accuracy of approximately 80% [13].…”

“…Upper gastrointestinal contrast series remain the reference to diagnosis in infants given an accuracy of 80% and the increased radiation risk associated with computed tomography [13,14], whereas findings on a plain radiography are often non-specific [15]. As demonstrated in our patient, in adults however computed tomography is very valuable in diagnosis with a diagnostic accuracy of approximately 80% [13]. In addition to the typical appearance of the right-sided duodenal-jejunal junction and displacement of the ileocaecal junction into epigastrium, a twist of the intestine around the SMA resulting in a so-called 'whirlpool' appearance can be an important diagnostic clue as shown in the current case (Fig.…”

Malrotación intestinal inusual en paciente adulto

“…La tomografía computarizada, ademá s de presentar exactitud diagnó stica del 80%, con una gran sensibilidad para detectar anormalidades en la posició n de la vena y la arteria mesenté rica superior 6 , aporta informació n sobre las posibles complicaciones asociadas 7,8 .…”