Intestinal malrotation, mesocolic hernia, and Meckel diverticulum - differential diagnosis of abdominal pain in adults: case report and literature review

Intestinal malrotation is a congenital anomaly caused by incomplete rotation or absence of rotation of the primitive intestine along the axis of the upper mesenteric artery during embryonic development. Embryonic development and its anatomical variations were described by Dott in 1923. Intestinal malrotation is a rare condition among adults - prevalent in a mere 0.0001% to 0.19% of the population -, and it may be associated with other anatomical deformities. It can be asymptomatic or manifest with varying intensity, from obstruction to necrosis of intestinal segments. In general, this abnormality is diagnosed in the first year of life; however, symptomsmay appear later in life,making diagnosis in adults difficult on account of non-specific symptoms. In the present study, we report a case of intestinal malrotation associated with chronic non-specific symptoms progressing to mesenteric angina. (AU)

Malrotación intestinal en adultos: causa infrecuentede obstrucción intestinal / Intestinal malrotation in adults: An uncommon cause of intestinal obstruction

La malrotación intestinal es una malformación congénita que afecta hasta al 1 % de la población. Aproximada-mente, el 90 % de los casos se presenta en la edad pediátrica y, rara vez, en la población adulta, lo que convierte a esta alteración en un reto para los profesionales sanitarios. Se presenta el caso de una paciente que se inició con un cuadro de obstrucción intestinal y abdomen agudo; se le diagnosticó malrotación intestinal, vólvulo y obstrucción por bridas, durante la laparotomía exploradora ur-gente. El conocimiento de condición patológica es imprescindible para poder brindarle un correcto tratamiento quirúrgico

The intestinal malrotation is a congenital malformation that affects up to 1% of the population. Approximately 90% of cases are diagnosed in the pediatric age and rarely in the adult population, which makes this pathology a challenge for health professionals.This is a case of a patient who presented with intestinal obstruction and acute abdomen that was diagnosed during the emergency exploratory laparotomy with intestinal malrotation, volvulus and obstruction. The knowledge of this pathology is essential to perform its correct surgical treatment

Congenital intestinal malrotation in children / 中国综合临床

Objective To summarize reasonable therapeutic measures by analyzing the characteristics of tardive intestinal malrotation in childhood. Methods Clinical data of 23 definitely diagnosed cases of intestinal mal-rotation from 1998 to 2008 were studied retrospectively. Results All of 23 patients were processed through plain ab-dominal radiograph;9 were examined with barium meal;2 were examined with barium enema;20 were examined by abdominal Doppler and 13 were examined by abdominal computer tomography. There were 18 patients who got final diagnosis preoperatively and the rate of final diagnosis was 78.3%. All of the cases were cured with Ladd's operative method. Conclusion Because tardive intestinal malrotation has various clinical manifestations,it is more difficult to diagnose than congenital intestinal malrotation in children. The main causes of death are intestinal volvulus and/or necrosis. At present,surgery is a traditional therapeutic way. Ladd procedure is the main traditional way to treat mal-trotation.

Laparoscopic Ladd's Procedure in a Child with Malrotation

Malrotation is rare in older children. We performed laparoscopic Ladd's procedure for a 14-year-old girl who was diagnosed with malrotation. She presented with a history of intermittent abdominal pain for 3 month. Diagnosis was made by UGI study and abdominal sonography. Laparoscopic exploration confirmed the diagnosis of malrotation. Laparoscopic Ladd's procedure and appendectomy were carried out. The patient was able to resume oral intake on the day of the operation, and was discharged 2 days after surgery. There was no further complaint during the 5 months of follow up, and the small incisional scar satisfied the patient and her parents. Our experience confirms that laparoscopy can be used for the diagnosis and treatment of children with malrotaton.

Laparoscopic Ladd’s procedure for intestinal malrotation in children / 中国微创外科杂志

Objective To explore the feasibility of laparoscopic Ladd’s procedure and its indications for intestinal malrotation accompanying midgut volvulus. Methods Laparoscopic Ladd’s procedure was performed in 15 children from July 2002 to March 2006. The procedure was performed using three trocars. Under laparoscopic visualization, the midgut volvulus was untwisted by grasping and pulling the intestine, the Ladd’s band was divided and broadened, the duodenum and the small intestine were mobilized, and finally an appendectomy was performed through an abdominal wall port. Results Laparoscopic Ladd’s procedure was completed successfully in the 15 children. Of them, 1 patient with duodenal web, 1 patient with paraduodenal hernia, and 1 patient with ectopic pancreas also had a concomitant procedure. The operative time was 45~150 min (mean, 75 min). The patients began to take food on 1~3 postoperative day. There was no surgical complications. The length of postoperative hospital stay ranged 4~6 days (mean, 5 days). Follow-up observations in 12 patients for 1~42 months (mean, 21 months) showed normal development and free of symptoms.Conclusions Laparoscopic Ladd’s procedure is a safe and effective technique. It can be performed in neonates and applicable subacute midgut volvulus, but may be unadvisable for acute volvulus with abdominal distention.