Total midgut volvulus in adults with intestinal malrotation. Report of eleven patients

Abstract

TSIVM is a very unusual finding in adult patients. The diagnosis can be made by CT scan with IV and oral contrast, but it often comes to light only at the time of surgery, even though the patients have often had recurrent episodes of abdominal symptomatology that dated back to childhood. The Ladd procedure, consisting of division of Ladd's bands, widening of the mesentery, and incidental appendectomy, remains the standard surgical repair. Digestive surgeons who care for adults should be familiar with this procedure, and it should be performed, as often as possible, with the assistance of a pediatric surgeon.

Rare case of midgut volvulus with malrotation in an elderly patient

“…Currently in the adult population CT scan with oral contrast can diagnose most of the cases. 8 Upper gastrointestinal series as shown in this case report may also be helpful when CT scan is contraindicated or not possible. 7 In this part of the world health insurance is a luxury and public hospitals are not well equipped, so patients usually end up paying the bills from their own pocket.…”

“…There is no proven standard surgical procedure for preventing the recurrence of small bowel volvulus, but most patient seems to do well with a simple de-rotation and retroperitoneal fixation of the right colon or a cecopexy. 3,8…”

A rare acute presentation of intestinal malrotation in the elderly

“…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.…”

An adult presentation of midgut volvulus secondary to intestinal malrotation: A case report and literature review

“…There was 92 adult cases of intestinal malrotation presenting acutely with midgut volvulus described in the published literature [ 4 , 8 , 10 , 12 , 15 , 17 , 18 , 21 , 24 , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] ]. The average age of presentation was 40 years old and there was a 1.7:1 ratio of male to female preponderance [ 4 , 8 , 10 , 12 , 15 , 17 , 18 , 21 , 24 , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] ]. The most common presenting symptoms were severe epigastric or umbilical pain, nausea and vomiting and distension; and all these symptoms were experienced by the patient in this case report [ 4 , 8 , 10 , 12 , 15 , 17 , 18 , 21 , 24 , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] ...…”

“…The average age of presentation was 40 years old and there was a 1.7:1 ratio of male to female preponderance [ 4 , 8 , 10 , 12 , 15 , 17 , 18 , 21 , 24 , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] ]. The most common presenting symptoms were severe epigastric or umbilical pain, nausea and vomiting and distension; and all these symptoms were experienced by the patient in this case report [ 4 , 8 , 10 , 12 , 15 , 17 , 18 , 21 , 24 , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] ]. Diagnosis of the midgut volvulus was predominantly made via CT (67%) but also made via ultrasound (15%) and intra-operatively (18%) [ 4 , 8 , 10 , 12 , 15 , 17 , 18 , 21 , 24 , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] ...…”