Abstract
Gut malrotation is usually a pediatric condition that presents mainly in the first month of life. It rarely presents in adults and is often a significant diagnostic dilemma to the surgeon. Failure to diagnose and treat this condition early may result in dire consequences like small gut gangrene. A previously healthy, 41-year-old female patient presented to the emergency department with a three-day history of lower abdominal pain and constipation. On examination, she had tachycardia, and her abdominal examination was soft, with mild tenderness in the hypogastric region and scanty bowel sounds. Urine pregnancy and dipstick were unremarkable. The patient was diagnosed with small bowel obstruction (malrotation of the small bowel loops with twisting of the mesenteric vessels). The patient was found to have thyrotoxicosis, which was the cause of the intestinal obstruction. She received conservative treatment and specific thyrotoxicosis management (carbimazole, cholestyramine, Lugol’s iodine, and intravenous hydrocortisone). The symptoms resolved entirely after a two-day stay at the intensive care unit.Small bowel malrotation is a congenital anomaly and can present with abdominal pain and obstruction in adulthood. Thyrotoxicosis can cause small bowel obstruction if there is underlying malrotation.
Highlights
Intestinal malrotation is a clinical condition characterized by a partial or complete failure of the midgut’s counterclockwise rotation around the fetal mesenteric vessels [1]
Because thyrotoxicosis may be lifethreatening if not treated on time, early diagnosis via thyroid function tests and intervention with betablockers may be necessary to minimize thyroid hormone production and secretion
We present a case of small bowel obstruction due to malrotation that presented with thyrotoxicosis
Summary
Intestinal malrotation is a clinical condition characterized by a partial or complete failure of the midgut’s counterclockwise rotation around the fetal mesenteric vessels [1]. A previously healthy, 41-year-old patient presented to the emergency department with a three-day history of lower abdominal pain and constipation Computed tomography (CT) scan with contrast confirmed a small bowel obstruction; a small bowel diameter of 34 mm; and malrotation of the small bowel loops with twisting of the mesenteric vessels (Figures 2-3) She was started on conservative treatment with intravenous fluids infusion, nil orally, placement of a nasogastric tube, which produced yellowish output, and specific thyrotoxicosis management such as carbimazole 20 mg every eight hours, cholestyramine, Lugol’s iodine, and intravenous hydrocortisone. She stayed in the intensive care unit for two days, and her symptoms resolved completely with the conservative treatment.
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