Abstract
IntroductionIntestinal malrotation is a rare condition, with an incidence estimated between 0,2 to 1%. Most cases are diagnosed and treated during childhood. Adult presentations are rare and most adults present with chronic nonspecific complaints.Midgut volvulus is the most feared complication of intestinal malrotation, far more common among the pediatric than the adult population. Presentation in adulthood with a midgut volvulus accounts for a minority of these patients (15%).The Ladd procedure is the standard surgical management of midgut volvulus and intestinal malrotation. Most evidence on the outcomes of the Ladd procedure originates from studies on pediatric population and the recurrence among children who have had a Ladd procedure is low (2–7%). Presentation of caseWe report an exceedingly rare case of a patient who presented in adulthood with a midgut volvulus and less than two years after undergoing Ladd procedure presented with a recurrence of the midgut volvulus. The recurrent midgut volvulus was successfully treated by a fixation procedure (cecopexy and duodenopexy). ConclusionReports of midgut volvulus in adult patients are scarce and reports of recurrence even scarcer hence the rate of recurrence among adult patients has yet to be determined. The recurrence rate in some of the available adult series is much higher than the rate reported among children.Should the rate of recurrence among adult patients prove higher, it poses the question of whether the Ladd procedure should be modified to include bowel fixation when performed in adults.
Highlights
Intestinal malrotation is a rare condition, with an incidence estimated between 0,2 to 1%
Congenital intestinal malrotation is commonly diagnosed during childhood: an estimated 90% of patients are diagnosed during the first year of life [1,2] and adult presentations are rare and reported to account for only 0.2-0.5% of intestinal malrotation cases [3,4,5,6]
Given the lower incidence of adult midgut volvulus the recurrence rate among adult patients is harder to estimate [3,5,6,7,8,9,10,17,18,19,20,21,22,23,24]
Summary
Intestinal malrotation is a rare condition, with an incidence estimated between 0,2 to 1%. Midgut volvulus is the most feared complication of intestinal malrotation, far more common among the pediatric than the adult population. The Ladd procedure is the standard surgical management of midgut volvulus and intestinal malrotation. PRESENTATION OF CASE: We report an exceedingly rare case of a patient who presented in adulthood with a midgut volvulus and less than two years after undergoing Ladd procedure presented with a recurrence of the midgut volvulus. The recurrent midgut volvulus was successfully treated by a fixation procedure (cecopexy and duodenopexy). Should the rate of recurrence among adult patients prove higher, it poses the question of whether the Ladd procedure should be modified to include bowel fixation when performed in adults
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