Midgut volvulus secondary to congenital malrotation in pregnancy

Chong, Eelyn; Liu, David S.; Rajagopal, Vishnupriya; Strugnell, Neil

doi:10.1136/bcr-2020-234664

Cited by 6 publications

(13 citation statements)

References 7 publications

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“…Midgut malrotation may induce various life-threatening acute abdominal diseases, involving volvulus, paraduodenal hernia, and gastroduodenal intussusception. [ 3 , 21 , 24 ] Most reports of midgut malrotation during pregnancy are complicated by acute abdominal diseases; therefore, surgical treatment is required, and reports on the treatment of patients with stable disease are lacking. Yin et al [ 25 ] proposed that the treatment method is consistent with that of intestinal obstruction; if complications such as intestinal volvulus, ischemia, and intestinal necrosis occur, malrotation can be treated conservatively, involving gastrointestinal decompression, parenteral nutrition, and antispasmodic drugs.…”

Section: Discussionmentioning

confidence: 99%

“…This condition typically presents in children [ 2 ] and rarely in adults, with an estimated incidence of 0.2% to 0.5%, excluding pregnancy. [ 3 ] At present, its etiology remains unclear, which is possibly related to mutations in forkhead box transcription factor ( FOXF1 ) and mutations in the gene BCL6 and L–R asymmetry genes. [ 4 – 6 ] Most patients have no obvious symptoms, and only a few may present with intermittent abdominal pain, nausea, and vomiting.…”

Section: Introductionmentioning

confidence: 99%

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Midgut malrotation presenting with hyperemesis gravidarum: A case report

Zhao

Yang

et al. 2022

Medicine

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Rationale: Midgut malrotation is a rare congenital abnormality resulting from failure of complete intestinal rotation and subsequent fixation during early fetal development. There appeared to be no obvious symptoms in most patients, and a few patients may exhibit symptoms similar to hyperemesis gravidarum, such as nausea and vomiting. Here, we present a case of midgut malrotation presenting as hyperemesis gravidarum.Patient concerns: A 27-year-old woman with an intrauterine pregnancy of 27 + 6 weeks complained of severe nausea and vomiting for 2 weeks.Diagnosis: Magnetic resonance imaging showed obvious dilatation in the proximal part of the duodenum and gastric cavity and the absence of a duodenal path dorsal to the superior mesenteric artery, which was diagnosed as midgut malrotation.Interventions: Considering that the patient's vital signs were stable, without manifestation of peritonitis or the risks of surgery to the fetus, conservative treatment was adopted. Unfortunately, the fetus developed severe hydrocephalus at 32 weeks. The patient and her family decided to abandon the fetus, and a mid-trimester-induced abortion was performed.Outcomes: The related symptoms completely disappeared after delivery, and the relevant examination after discharge also confirmed the presence of midgut malrotation without gastrointestinal discomfort within 1 year after delivery.Lessons: Midgut malrotation can be considered as a differential diagnosis of hyperemesis gravidarum. Conservative treatment under close monitoring is desirable in pregnant women diagnosed with midgut malrotation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Midgut malrotation presenting with hyperemesis gravidarum: A case report

Zhao

Yang

et al. 2022

Medicine

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“…Along with other scattered publications, Ladd's procedure and increasing age reduced but did not prevent the risk of volvulus. [15][16][17][18][19][20][21][22][23][24][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] Patients with intact gut experienced digestive symptoms which were commonly incapacitating. With the first adult case being reported in 1960s, recent literature highlighted the common development of GM symptoms in both adults and children.…”

Section: Discussionmentioning

confidence: 99%

Five Hundred Patients With Gut Malrotation

et al. 2021

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Objectives: Define clinical spectrum and long-term outcomes of gut malrotation. With new insights, an innovative procedure was introduced and predictive models were established. Methods: Over 30-years, 500 patients were managed at 2 institutions. Of these, 274 (55%) were children at time of diagnosis. At referral, 204 (41%) patients suffered midgut-loss and the remaining 296 (59%) had intact gut with a wide range of digestive symptoms. With midgut-loss, 189 (93%) patients underwent surgery with gut transplantation in 174 (92%) including 16 of 31 (16%) who had autologous gut reconstruction. Ladd's procedure was documented in 192 (38%) patients with recurrent or de novo volvulus in 41 (21%). For 80 patients with disabling gastrointestinal symptoms, gut malrotation correction (GMC) surgery “Kareem's procedure” was offered with completion of the 270° embryonic counterclockwise-rotation, reversal of vascular-inversion, and fixation of mesenteric-attachments. Concomitant colonic dysmotility was observed in 25 (31%) patients. Results: The cumulative risk of midgut-loss increased with volvulus, prematurity, gastroschisis, and intestinal atresia whereas reduced with Ladd's and increasing age. Transplant cumulative survival was 63% at 10-years and 54% at 20-years with best outcome among infants and liver-containing allografts. Autologous gut reconstruction achieved 78% and GMC had 100% 10-year survival. Ladd's was associated with 21% recurrent/de novo volvulus and worsening ( P > 0.05) of the preoperative National Institute of Health patient-reported outcomes measurement information system gastrointestinal symptom scales. GMC significantly ( P ≤ 0.001) improved all of the symptomatology domains with no technical complications or development of volvulus. GMC improved quality of life with restored nutritional autonomy ( P < 0.0001) and daily activities ( P < 0.0001). Conclusions: Gut malrotation is a clinicopathologic syndrome affecting all ages. The introduced herein definitive correction procedure is safe, effective, and easy to perform. Accordingly, the current standard of care practice should be redefined in this orphan population.

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“…In the search results, we did not find any reported cases of volvulus in pregnancy caused by reverse rotation. Nine cases of volvulus caused by other types of intestinal malrotation were found[ 2 , 19 - 26 ]. Among them, 5 cases had extensive midgut volvulus and intestinal necrosis[ 19 , 20 , 23 , 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Intestinal obstruction in pregnancy with reverse rotation of the midgut: A case report

Zhao¹,

Wang²,

Li³

et al. 2020

WJCC

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BACKGROUND Reverse rotation of the midgut is a rare type of intestinal malrotation. Volvulus of the right colon or entire midgut, stenosis of the transverse colon and obstruction of the duodenojejunal junction are common complications of reverse rotation. In this study, we report the first case of intestinal obstruction associated with reverse rotation in pregnancy. CASE SUMMARY A 31-year-old woman at 36 +2 wk gestation presented to the emergency department with progressive abdominal cramping, nausea and bilious vomiting. Abdominal ultrasound scanning showed dilatation of the bowel. Computed tomography scanning revealed features of reverse rotation of the midgut with intestinal volvulus. After consultation with the obstetrician, the pregnancy was terminated and exploratory abdominal surgery was performed. Intra-operatively, it was found that the mesentery of the colon and small intestine was insufficiently attached. The right colon and the small intestinal mesentery was twisted, and intestinal necrosis was observed. The duodenum and duodenojejunal junction were curved in front of the transverse colon, and the transverse colon passed through the tunnel behind the mesenteric root. Intestinal reverse rotation with volvulus was confirmed. The ‌necrotic intestine was resected and small intestine mesenteric reconstruction was performed. The patient recovered after surgery. After leaving the hospital, the patient and her daughter remained well during an 8-month follow-up period. CONCLUSION We report the diagnosis, treatment and etiology of a pregnant patient with intestinal obstruction due to reverse rotation of the midgut. For similar cases, appropriate diagnosis and treatment should be carried out according to the condition of the fetus and pregnant woman.

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Midgut volvulus secondary to congenital malrotation in pregnancy

Cited by 6 publications

References 7 publications

Midgut malrotation presenting with hyperemesis gravidarum: A case report

Midgut malrotation presenting with hyperemesis gravidarum: A case report

Five Hundred Patients With Gut Malrotation

Intestinal obstruction in pregnancy with reverse rotation of the midgut: A case report

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