Surgical management of intestinal malrotation in adults

Fu, Tao; Tong, Weidong; He, Y.; Wen, Ya Yuan; Luo, Dong Lin; Liu, Bob

doi:10.1007/s00268-007-9018-2

Cited by 61 publications

(90 citation statements)

References 32 publications

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“…Recurrent symptoms in such cases are usually considered to be due to adhesions and one may be inclined to adopt a non-operative approach. Fu et al [16] reported only two recurrences in a series of 12 adults treated for symptomatic malrotation with one of them requiring a reoperation and the other managed conservatively. It is believed that the increasing use of CT scan will enable one to make such diagnosis with certainty preoperatively as this has the overall advantage of detecting the abnormal location of the midgut as well as any other intraabdominal anomalies.…”

Section: Discussionmentioning

confidence: 99%

“…Recurrent volvulus as a cause of bowel obstruction following Ladd's operation for midgut malrotation is very rare both in children and adult life and very few of such cases have been reported in literature [15][16][17][18][19][20][21] (Table 1). Recurrent symptoms in such cases are usually considered to be due to adhesions and one may be inclined to adopt a non-operative approach.…”

Section: Discussionmentioning

confidence: 99%

“…It was difficult to ascertain the full details of the procedure(s) performed in our patient in childhood as the operation took place in a different hospital with una- [16] 2007 3 2-recurrent volvulus 1-adhesive bowel obstruction 1-surgery 1-conservative treatment Mazeh et al [17] 2007…”

Section: Discussionmentioning

confidence: 99%

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Recurrent intestinal volvulus in midgut malrotation causing acute bowel obstruction: A case report

Sheikh¹

2013

WJGS

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Intestinal malrotation occurs when there is a disruption in the normal embryological development of the bowel. The majority of patients present with clinical features in childhood, though rarely a first presentation can take place in adulthood. Recurrent bowel obstruction in patients with previous abdominal operation for midgut malrotation is mostly due to adhesions but very few reported cases have been due to recurrent volvulus. We present the case of a 22-year-old gentleman who had laparotomy in childhood for small bowel volvulus and then presented with acute bowel obstruction. Preoperative computerised tomography scan showed small bowel obstruction and features in keeping with midgut malrotation. Emergency laparotomy findings confirmed midgut malrotation with absent appendix, abnormal location of caecum, ascending colon and small bowel. In addition, there were small bowel volvulus and a segment of terminal ileal stricture. Limited right hemicolectomy was performed with excellent postoperative recovery. This case is presented to illustrate a rare occurrence and raise an awareness of the possibility of dreadful recurrent volvulus even several years following an initial Ladd's procedure for midgut malrotation. Therefore, one will need to exercise a high index of suspicion and this becomes very crucial in order to ensure prompt surgical intervention and thereby preventing an attendant bowel ischaemia with its associated high fatality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Recurrent intestinal volvulus in midgut malrotation causing acute bowel obstruction: A case report

Sheikh¹

2013

WJGS

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“…Its white cell count Counterclockwise detorsion of the bowel, division of the coloduodenal band and division of adhesions around the superior mesenteric artery to broaden the base of the mesentery were performed. (13) Importantly, there were no lymphatic malformations, enlarged lymph nodes or retroperitoneal tumours at the root of the mesentery and retroperitoneum, which might have obstructed the lymphatic flow. Hence, the cause of the chylous ascites could be confidently attributed to intestinal malrotation, which resulted in temporary lymphatic obstruction.…”

Section: Discussionmentioning

confidence: 99%

Intestinal torsion causing chylous ascites: a rare occurrence

Koh

Ch’ng²,

Tan³

et al. 2013

SMedJ

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C a s e R e p o r t e88 INTRODUCTIONSince the first case of acute chylous peritonitis described by Renner (1) CASE REPORTA Computed tomography (CT) showed a whirl-like appearance, with a collapsed bowel around the superior mesenteric artery (Fig. 1). There was also an abrupt cut-off of the superior mesenteric vein just distal to the splenoportal confluence (Fig. 2). This was suggestive of intestinal torsion.On exploratory laparotomy, two litres of chylous fluid was drained from the peritoneal cavity. The small bowel mesentery was torted around an adhesion band between the transverse colon and duodenum. The small bowel mesentery was found to be long and narrow, and the position of the caecum was to the right and more cranial than usual. The bowel was well-perfused, pink and only mildly dilated. Superior mesenteric arterial pulsations were prominent.The bowel was detorted in a counterclockwise manner and the coloduodenal adhesion band was taken down. AdhesionsIntestinal torsion causing chylous ascites: a rare occurrence ABSTRACT Intestinal torsion and chylous ascites are very rarely associated. We present the case of a 19-year-old man who presented with acute abdomen. Computed tomography of his abdomen showed features suggestive of intestinal torsion. Chylous ascites was incidentally discovered on exploratory laparotomy. The chylous fluid was drained, the small bowel detorted and the coloduodenal adhesion band taken down. The patient's retroperitoneum was explored to exclude occult masses and malformations of the lymphatics. Post surgery, the patient recovered uneventfully. In this case, we postulate that intestinal malrotation had caused the obstruction of the lymphatic flow from the mesenteric lymphatic channels, leading to the exudation of chyle, which then resulted in the accumulation of chylous fluid in the peritoneal cavity. It is important to exclude the more common causes of atraumatic chylous ascites, such as enlarged retroperitoneal lymph nodes or lymphatic malformations.

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“…All patients diagnosed to have malrotation need to be operated as the surgery is associated with least morbidity and the consequences of not intervening may be life threatening [18]. However, this is a point of debate.…”

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confidence: 99%