Malrotation of midgut in adults, an unsuspected and neglected condition—An analysis of 64 consensus confirmed cases

Prasad, G Raghavendra; Rao, J V Subba; Fatima, Humera; Shareef, Hameed Mohd; Shah, Asif Iqbal; Satyanarayana, Gowri

doi:10.1007/s12664-015-0596-x

Cited by 7 publications

(7 citation statements)

References 12 publications

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“…Midgut volvulus secondary to intestinal malrotation is a rare condition in the elderly with very few cases reported in literature. 3,[5][6][7][8][9][10][11][12][13][14] The first case in the elderly was probably reported in 1992 by Izes et al at the Lahey Clinic Medical Centre, USA. 15 Its rarity therefore portends a challenge in diagnosis and this mostly dependent on a high index of suspicion.…”

Section: Discussionmentioning

confidence: 99%

“…[20][21][22] Abdominal CT scan can demonstrate SMV in anomalous location posterior and left of the SMA even though patients with malrotation may have a normal SMA-SMV orientation, and an abnormality of SMA-SMV relationship may be due to a normal variant and not necessarily intestinal malrotation. 7,23 Also, midgut and duodenum may be noted not to cross the spine. In the presence of associated volvulus, besides the above findings, the "whirl-pool sign" may also be demonstrated.…”

Section: Discussionmentioning

confidence: 99%

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A rare acute presentation of intestinal malrotation in the elderly

2020

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Intestinal malrotation, a congenital anomaly of the midgut, typically presents in pediatrics age group with the most feared complication of midgut volvulus and its catastrophic sequelae. Midgut volvulus secondary to intestinal malrotation is a rare presentation in adults more so in the elderly. Its rarity portends a diagnostic dilemma for both the surgeon and radiologist. We report a 65-year-old man admitted following a referral with a 12-hour history of acute abdomen with an initial diagnosis of acute pancreatitis but later had laparotomy with intraoperative findings of a midgut volvulus and gangrenous ileal segment secondary to intestinal malrotation. This case emphasizes the importance of early diagnosis to prevent the disastrous complication of this disease. The rarity of this condition portends a formidable diagnostic challenge in adults hence the awareness of its possibility and a high index of suspicion is crucial in diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A rare acute presentation of intestinal malrotation in the elderly

2020

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“…The site of DJJ or the duodenojejunal flexure should be precisely evaluated as it is the anatomical landmark. [ 9 ] The normal position of the DJJ is typically lateral to the left pedicle of the vertebral body at the level of the duodenal bulb in coronal view. CT can determine the variant of malrotation; however, many radiologists do not describe these findings in their daily reports.…”

Section: Discussionmentioning

confidence: 99%

Short bowel syndrome caused by laparoscopic loop enterostomy of the jejunum in an adult with undiagnosed intestinal malrotation

Hsu

Huang

et al. 2018

Medicine

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Rationale:Failure to recognize intestinal malrotation in adults can cause complications during surgeries, especially those with a limited operative field. We report a case of short bowel syndrome caused by mistaken creation of a loop enterostomy in the jejunum due to undiagnosed intestinal malrotation.Patient concerns:A 72-year-old man underwent a laparoscopic right hemicolectomy and ileocolostomy because of complicated diverticulitis. Six days after the surgery, he received laparoscopic exploration because of anastomotic leak, and a laparoscopic loop ileostomy was also performed as a protective diversion stoma. One month after surgery, he complained of severe diarrhea from the enterostomy after food and water intake. An upper gastrointestinal and small bowel series revealed that the duodenojejunal junction (DJJ) did not cross the midline and there was a short distance between the DJJ and the enterostomy in the right lower quadrant.Diagnoses:Short bowel syndrome caused by mistaken creation of a loop enterostomy in the jejunum due to undiagnosed intestinal malrotation.Interventions:Total parental nutrition was used and the loop enterostomy was closed 3 months after the initial surgery.Outcomes:The patient was discharged uneventfully 2 weeks after the loop enterostomy.Lessons:Intestinal malrotation in adults is often encountered during routine radiological examinations. However, it may cause complications during surgery if ignored. Radiologists should keep in mind that complications may occur if a complete presurgical evaluation of intestinal malrotation is not performed, and surgeons should take caution when performing surgeries, especially those with a limited operative field.

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“…As the symptoms are thus often nonspecific, and the condition being less common, the clinician less often attributes this to malrotation. In the article on IM in adults published in this issue of the Journal, the authors, analyzing 64 cases of IM, repeatedly emphasize that patients with chronic, recurrent abdominal pain are often treated erroneously and the diagnosis of malrotation is often missed [8].…”

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confidence: 99%

“…The authors reiteratively lament the apathy of treating physicians missing the diagnosis even after performing several investigations like upper GI endoscopy, barium meal series, barium enema, ultrasound, and CECT, often more than once [8]. He stresses that the diagnosis is missed even after diagnostic laparoscopy.…”

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confidence: 99%