Procedimento de ladd para má rotação intestinal no adulto: relato de caso

Complete Intestinal Malrotation in Adult Associated to Intestinal Sub-Occlusion: Case Report

“…Thus, when in adolescents and adults, it represents a diagnostic challenge, due to symptoms similar to several other abdominal pathologies [1]. Among symptomatic patients, the evolution may occur in acute form -with vomit and abdominal pain as intestinal obstruction and ischemia associated with intestinal or ileocecal volvo -or chronic, with vague and intermittent abdominal pain, although most cases are seen in asymptomatic patients, who are diagnosed accidentally [6]. Among symptomatic patients, the evolution may occur in acute form -with vomiting and abdominal pain that may progress to ischemia and intestinal necrosis, derived from volvos or internal hernias or in chronic form, presenting nonspecific symptoms, such as intermittent abdominal pain, diarrhea, early satiety, recurrent nausea and vomiting [1,4].…”

“…The purpose of this procedure is to reduce the risk of acute volvos by locating the small intestine in a non-rotating position and widening the base of the mesentery. Appendectomy is done prophylactically because of the eventual difficulty in diagnosing acute appendicitis in the future, being the cecal appendix distant from the usual position [6].…”

Intestinal malrotation associated with duodenal obstruction secondary to Ladd's bands

“…Those aspects are found in classical malrotation with duodenal obstruction secondary to Ladd's bands ( Figure 2A ). The patient underwent laparoscopy Ladd's procedure ( Figure 2B ) and was subsequently discharged in good condition, thereafter reporting no episodes of recurrence ( 1 , 2 ) .…”

“…Most cases are diagnosed during the neonatal period, only 0.2% being diagnosed in adulthood. The condition can lead to chronic nonspecific symptoms in young adults, making it difficult to diagnose ( 1 , 2 , 10 ) .…”

“…This aim of the treatment is to reduce the risk of acute-onset volvulus by placing the small intestine in a nonrotating position and broadening the base of the mesentery. Appendectomy is performed because of potential difficulty in diagnosing appendicitis in the future, given that the appendix would be far from the correct position ( 1 , 11 , 12 ) .…”