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. 2014;5(5):259-61.
doi: 10.1016/j.ijscr.2014.02.013. Epub 2014 Mar 13.

Intestinal malrotation and volvulus in adult life

Bastiaan W Haak  1 , Sander T Bodewitz  2 , Caroline F Kuijper  3 , Louise M de Widt-Levert  4
Affiliations

Intestinal malrotation and volvulus in adult life

Bastiaan W Haak et al. Int J Surg Case Rep. 2014.

Abstract

Introduction: Midgut volvulus due to intestinal malrotation is a rare cause of intestinal obstruction when occurring in adult life. This paper documents the difficulties in reaching an early diagnosis.

Presentation of case: We describe the case of an 85-year-old man with non-specific abdominal complaints for 20 years, who presented with sudden onset central abdominal pain. An acute median laparotomy under general anaesthesia was performed during which a 360° clockwise rotation of the small bowel around the mesenteric pedicle of the superior mesenteric artery and vein was found.

Discussion: Malrotation is considered any deviation of the normal rotation of the midgut in embryological development, causing intermittent episodes of gastrointestinal obstruction or acute events of midgut volvulus. Although mainly a paediatric diagnosis, some cases do present in adult life. Radiologic investigations include: upper gastrointestinal contrast studies, Doppler sonography and a contrast enhanced CT of the abdomen. If a true malrotation is diagnosed or found by coincidence, a Ladd's procedure is advised, even if the patient is asymptomatic. There is no proven surgical strategy for preventing the recurrence of small bowel volvulus in case of malfixation of the midgut.

Conclusion: Non-specific recurrent abdominal complaints in adults of any age should raise suspicion of the possibility of a midgut malrotation or malfixation with or without intermittent volvulus. This case highlights the importance of diagnosis in an early stage.

Keywords: Malrotation; Volvulus.

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Figures

Fig. 1
Fig. 1
An abdominal computed tomography (CT) scan without contrast showed a whirl sign (arrow), suggesting a volvulus.
Fig. 2
Fig. 2
Schematic reproduction of the 360° clockwise rotation of the small bowel around the mesenteric pedicle of the superior mesenteric artery (SMA).
Fig. 3
Fig. 3
The small bowel was oedematous and purple in color.
Fig. 4
Fig. 4
Upper gastrointestinal contrast series showing a significant amount of jejunal diverticulosis.
Fig. 5
Fig. 5
Abdominal CT-scan showing a SMA—SMV inversion with the vein (white arrow) rotating around the artery (blue arrow).
See this image and copyright information in PMC

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