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Surgical management of intestinal malrotation in adults

World Journal of Surgery volume 31, pages 1797–1803 (2007)Cite this article

Abstract

Objective

The aim of this study was to review our experience with diagnosis and surgical management of intestinal malrotation in adult patients.

Patients and Methods

A retrospective review of the surgical outcome of adults with intestinal malrotation was performed. Twelve patients were observed and treated between July 1996 and July 2006 (4 women and 8 men; the mean age of the patients was 28.5 years). Surgical outcomes, including postoperative complications, deaths, and resolution of preoperative symptoms, were measured.

Results

A diagnosis of malrotation was made preoperatively in five patients by upper gastrointestinal contrast study, barium enema, or computed tomography scan. The anomaly was discovered incidentally at laparotomy in seven patients. All cases were proved to be malrotation intraoperatively. Nine patients underwent laparotomy and three underwent laparoscopic surgery (one converted to an open procedure). Follow-up ranged from 2 months to 118 months. Three patients had complications: one had wound infection, one had delayed gastric emptying, and one developed adhesive ileus. There were only two recurrences detected and one patient with recurrence required reoperation. No one died.

Conclusions

Intestinal malrotation is a rare but important cause of abdominal pain in adults. It may present with chronic or acute symptoms. Laparotomy and laparoscopy are alternative and feasible techniques with low rates of complications for the treatment of intestinal malrotation in adults.

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References

  1. Mazziotti MV, Strasberg SM, Langer JC (1997) Intestinal rotation abnormalities without volvulus: the role of laparoscopy. J Am Coll Surg 185:183–187

    Google Scholar 

  2. Gamblin TC, Stephens RE Jr, Johnson RK, et al. (2003) Adult malrotation: a case report and review of the literature. Curr Surg 60:517–520

    PubMed  Article  Google Scholar 

  3. Puvaneswary M, Rajajatnam S (2003) Midgut volvulus in an adult. Australas Radiol 47:83–84

    PubMed  Article  CAS  Google Scholar 

  4. Dietz DW, Walsh RM, Grundfest-Broniatowski S, et al. (2002) Intestinal malrotation: a rare but important cause of bowel obstruction in adults. Dis Colon Rectum 45:1381–1386

    PubMed  Article  Google Scholar 

  5. Garg RC, Sharma J, Kumar N, et al. (2001) Symptomatic volvulus due to mid gut malrotation in an adult. Trop Gastroenterol 22:93–94

    PubMed  CAS  Google Scholar 

  6. Matzke GM, Moir CR, Dozois EJ (2003) Laparoscopic Ladd procedure for adult malrotation of the midgut with cocoon deformity: report of a case. J Laparoendosc Adv Surg Tech A 13:327–329

    PubMed  Article  Google Scholar 

  7. McIntosh R, Donovan EJ (1939) Disturbances of rotation of the intestinal tract. Am J Dis Child 57:116–166

    Google Scholar 

  8. Kiesewetter WB, Smith JW (1958) Malrotation of midgut in infancy and childhood. AMA Arch Surg 77:483–491

    PubMed  CAS  Google Scholar 

  9. Forrester MB, Merz RD (2003) Epidemiology of intestinal malrotation, Hawaii, 1986–99. Paediatr Perinat Epidemiol 17:195–200

    PubMed  Article  Google Scholar 

  10. Rowsom JT, Sullivan SN, Girvan DP (1987) Midgut volvulus in the adult. J Clin Gastroenterol 9:212–216

    PubMed  Article  CAS  Google Scholar 

  11. Matzke GM, Dozois EJ, Larson DW, et al. (2005) Surgical management of intestinal malrotation in adults: comparative results for open and laparoscopic Ladd procedures. Surg Endosc 19:1416–1419

    PubMed  Article  CAS  Google Scholar 

  12. Zissin R, Rathaus V, Oscadchy A, et al. (1999) Intestinal malrotation as an incidental finding on CT in adults. Abdom Imaging 24:550–555

    PubMed  Article  CAS  Google Scholar 

  13. Kapfer SA, Rappold JF (2004) Intestinal malrotation—not just the pediatric surgeon’s problem. J Am Coll Surg 199:628–635

    PubMed  Article  Google Scholar 

  14. Prasil P, Flageole H, Shaw KS (2000) Should malrotation in children be treated differently according to age? J Pediatr Surg 35:756–8

    PubMed  Article  CAS  Google Scholar 

  15. Wang TK, Yeh CH (1998) Computed tomography in the diagnosis of adult midgut rotational anomalies: a report of two cases. J Gastroenterol 33:102–106

    PubMed  Article  CAS  Google Scholar 

  16. Nichols DM, Li DK (1983) Superior mesenteric vein rotation: a CT sign of midgut malrotation. Am J Roentgenol 141:707–708

    CAS  Google Scholar 

  17. Fisher JK (1981) Computer tomographic diagnosis of volvulus in intestinal malrotation. Radiology 140:145–146

    PubMed  CAS  Google Scholar 

  18. Pracros JP, Sann L, Genin G, et al. (1992) Ultrasound diagnosisi of midgut volvulus: the ‘whirlpool’ sign. Pediatr Radiol 22:18–20

    PubMed  Article  CAS  Google Scholar 

  19. Nichols DM (2000) The ultrasonic barberpole: midgut volvulus and malrotation in a young adult. Clin Radiol 55:400–402

    PubMed  Article  CAS  Google Scholar 

  20. Ladd WE (1936) Surgical diseases of the alimentary tract in infants. N Engl J Med 215:705

    Article  Google Scholar 

  21. Choi M, Borenstein SH, Hornberger L, et al. (2005) Heterotaxia syndrome: the role of screening for intestinal rotation abnormalities (May 12). Arch Dis Child 90:813–15

    PubMed  Article  CAS  Google Scholar 

  22. Murphy FL, Sparnon AL (2006) Long-term complications following intestinal malrotation and the Ladd’s procedure: a 15 year review. Pediatr Surg Int 22:326–329

    PubMed  Article  Google Scholar 

  23. Gillbert HW, Armstrong CP, Thompson MH (1990) The presentation of malrotaion of the intestine in adults. Ann R Coll Surg Engl 72:239–242

    Google Scholar 

  24. Kalfa N, Zamfir C, Lopez M, et al. (2004) Conditions required for laparoscopic repair of subacute volvulus of the midgut in neonates with intestinal malrotation. Surg Endosc 18:1815–1817

    PubMed  Article  CAS  Google Scholar 

  25. Yamashita H, Kato H, Uyama S, et al. (1999) Laparoscopic repair of intestinal malrotation complicated by midgut volvulus. Surg Endosc 13:1160–1162

    PubMed  Article  CAS  Google Scholar 

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Affiliations

  1. Department of General Surgery, Daping Hospital & Field Surgery Institution, The Third Military Medical University, Chongqing, China

    Tao Fu, Wei Dong Tong, Yu Jun He, Ya Yuan Wen, Dong Lin Luo & Bao Hua Liu

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  1. Tao Fu
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  2. Wei Dong Tong
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  3. Yu Jun He
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Correspondence to Tao Fu.

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Fu, T., Tong, W.D., He, Y.J. et al. Surgical management of intestinal malrotation in adults. World J Surg 31, 1797–1803 (2007). https://doi.org/10.1007/s00268-007-9018-2

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Keywords

  • Irritable Bowel Syndrome
  • Appendicitis
  • Superior Mesenteric Artery
  • Barium Enema
  • Abdominal Complaint