Abstract
Midgut malrotation is an anomaly of intestinal rotation that occurs during fetal development and usually presents in the neonatal period. We present a rare case of malrotation in a 14-year-old patient who presented with cramping, generalized right abdominal pain, and vomiting for a duration of one day. A computed tomography abdominal scan and upper gastrointestinal contrast studies showed malrotation of the small bowel without volvulus. Laparoscopy revealed typical Ladd’s bands and a distended flabby third and fourth duodenal portion extrinsically obstructing the misplaced duodeno-jejunal junction. The Ladd procedure, including widening of the mesenteric base and appendectomy, was performed. Symptoms completely resolved in a half-year follow up period. Patients with midgut malrotation may present with vague abdominal pain, intestinal obstruction, or intestinal ischemia. The laparoscopic Ladd procedure is feasible and safe, and it appears to be as effective as the standard open Ladd procedure in the diagnosis and treatment of teenage or adult patients with intestinal malrotation.
Highlights
Midgut malrotation is a congenital anomaly of intestinal rotation presenting mainly in childhood, usually within the first month of life
Midgut malrotation refers to a failure in the counter-clockwise rotation of the midgut, which results in the misplacement of the duodeno-jejunal junction to the right midline, comprising non-rotation and incomplete rotation of the superior mesenteric artery
Older children and adolescents are likely to present with recurrent abdominal pain, intermittent obstructive symptoms, or failure to thrive due to intestinal obstruction or intestinal ischemia [1,2,3,4]
Summary
Midgut malrotation is a congenital anomaly of intestinal rotation presenting mainly in childhood, usually within the first month of life. Presentation of case A 14-year-old man presented to our emergency center with cramping and generalized abdominal pain. Multiple presentations with similar symptoms during his teenage years had failed to identify the cause of his pain. He had no history of previous abdominal surgeries. The patient’s vital signs were: pulse, 67 beats/minute; blood pressure, 121/61 mmHg; body temperature, 36.9°C; and respiration rate, 15 breaths/minute He was well-nourished and alert without cyanosis. His abdomen was not distended, but his bowel sounds were weak He exhibited no peritoneal signs; mild diffuse tenderness to deep palpation was noted. Opacified small bowel presented almost entirely on the right side (Figure 1B). The patient was discharged two days later and has remained asymptomatic without recurrence of abdominal pain three months postoperatively
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