Diagnosis Of Intestinal Malrotation Research Articles

Current view on the diagnosis of intestinal malrotation in neonates: radiologic and ultrasound imaging techniques

Current view on the diagnosis of intestinal malrotation in neonates: radiologic and ultrasound imaging techniques

EGS P31 Small bowel obstruction in an elderly female secondary to congenital Ladd’s band. A rare case presentation

Abstract Background Intestinal malrotation is a congenital anomaly which arises during embryonic development. This can be associated with peritoneal tissue known as Ladd’s bands which can cause predisposition to intestinal obstruction. The incidence of intestinal malrotation is reported to be approximately 0.2% in the adult population [G]. Cases of intestinal obstruction secondary to malrotation commonly present in the paediatric population, but rarely may only be detected at adulthood. We present an elderly women who presented with features suggestive small bowel obstruction. Methods We present a rare case of a 78 year old female presenting with a three day history of coffee-ground vomiting, abdominal pain and dizziness. The patient had a notable background of a hiatus hernia and atrial fibrillation for which she was being treated with edoxaban. An abdominal X-ray film showed faecal loading. CT imaging revealed a high-grade small-bowel obstruction with an acute transitional point at the terminal ileum secondary to congenital Ladd's band which was confirmed at laparotomy. Subsequently, a Ladd’s procedure was performed and the patient was discharged after making a good recovery. Results In this case report, we highlight the importance of considering congenital anomalies in patients presenting with symptoms of bowel obstruction. We discuss the importance of appropriate investigations as well as multidisciplinary care to help facilitate early diagnosis. Conclusions Congenital Ladd’s band is a rare cause of small bowel obstruction in an elderly population. Although the diagnosis of intestinal malrotation can be challenging in adulthood, congenital anomalies should be considered as a differential in patients presenting with symptomatic obstruction.

Ultrasound imaging as the first line of investigation to diagnose intestinal malrotation in children: Safety and efficacy

BackgroundUpper gastrointestinal contrast study is considered the gold standard investigation to diagnose intestinal malrotation and midgut volvulus which is potentially devastating condition. Ultrasound imaging is an alternative but has been considered unreliable due to significant false negative results. At our institution we have been using ultrasound imaging as the first line investigation to diagnose malrotation since 2008 with a preliminary study of 139 patients published in 2014. This is an ongoing audit of a further much larger cohort of patients to determine the efficacy and safety of ultrasound imaging in the diagnosis of intestinal malrotation. Materials and methodsFollowing ethics approval, a retrospective analysis of a prospectively collected patient database undergoing ultrasound scans to exclude malrotation at our centre was performed from 2012 to 2019. Results539 patients underwent ultrasound to assess for malrotation. The mean age of presentation was 365 days (median 30 days, mode 1 day). Malrotation was diagnosed in 17 with 5 having volvulus, with findings confirmed at surgery. 12 had equivocal findings and subsequent contrast studies ruled out malrotation. The remaining 510 patients with no evidence of malrotation were managed conservatively. ConclusionWe have shown ultrasound to be a safe and effective tool to assess intestinal malrotation without exposure to ionizing radiation. Level of evidenceLevel IV

Chronic midgut volvulus - A challenging diagnosis

Chronic midgut volvulus is a rare condition and the diagnosis can pose a serious challenge. We present the case of an 8 year old girl, with a long-standing history of atypical gastrointestinal symptoms. Although extensive evaluation was performed, the diagnosis of intestinal malrotation with chronic volvulus was only established after 5 years. Her symptoms resolved after corrective surgery. This case report underlines the importance of considering malrotation in the differential diagnosis of patients that present beyond infancy with vague nonspecific gastrointestinal complaints, as a misdiagnosis can result in a catastrophic outcome.

Visceral variations in adult intestinal malrotation: A case-series study

Aim: Intestinal malrotation (IM) is a very rare rotational anomaly of midgut. Although uncommon, failure to diagnose IM may lead to devastating consequences. It is important that radiologists and surgeons are made aware of the diagnosis of adult IM and accompanying variations. Since IM is usually reported as a case report, it is important to note the frequency of the accompanying variations. It is aimed to present radiological findings of intestinal malrotation, increase awareness of abdominal variations and pathologies accompanying adult IM and reduce diagnostic failure. Methods: Thirty-two patients aged over 18 years, who underwent computed tomography (CT) and received a diagnosis of IM, were retrospectively evaluated in terms of CT findings. Aplasia or hypoplasia of the uncinate process of the pancreas, focal thickening areas that may cause suspicion of a pseudomass, location of the superior mesenteric vein relative to the superior mesenteric artery, localization of the cecum, and the frequency of a redundant sigmoid colon were determined. Results: The frequency of IM in adults undergoing CT was 1/5,375. In two of 32 cases, the cause of acute abdomen was identified while the other cases were detected incidentally. Aplasia or hypoplasia of the uncinate process of the pancreas and a redundant sigmoid colon were detected in 21 (65.6%) and 23 (71.9%) cases, respectively. The cecum was in the normal location in eight patients (25%), and there was a normal superior mesenteric artery-vein relationship in six (18.8%). Conclusion: Intestinal malrotation is rarely encountered in adults and most cases are incidentally detected. IM is often accompanied by aplasia or hypoplasia of the uncinate process of the pancreas. A normal superior mesenteric artery-vein relationship and the cecum in the normal position are seen in one out of every four to five cases.

Можливості ультрасонографії у діагностиці мальротації кишок: власні спостереження та огляд літератури

Можливості ультрасонографії у діагностиці мальротації кишок: власні спостереження та огляд літератури

Laparoscopic Management of Intestinal Malrotation With Cocoon Deformity: A Case Report

Intestinal malrotation is diagnosed and treated mostly in infancy and childhood, but it is rarely encountered in adults. Here, we present a case of adult intestinal malrotation with cocoon deformity that was managed by a laparoscopic procedure. A 71-year-old man presented with intermittent abdominal pain, nausea, and vomiting. Preoperative findings from abdominal computed tomography, upper gastrointestinal contrast imaging, and enema examination showed intestinal malrotation without volvulus. Diagnostic laparoscopy revealed nonrotation of the midgut, and most of the small bowels were contained in a large peritoneal sac without strangulation. With a definitive diagnosis of intestinal malrotation with cocoon deformity, further laparoscopic repair was performed by widely opening the peritoneal sac, and widening the base of the mesenteric pedicle to prevent future volvulus. There were no postoperative complications. The laparoscopic approach for intestinal malrotation with cocoon deformity can be a safe and useful technique. With the advantage of its minimal invasiveness, it can be an alternative to laparotomy.

Adult intestinal malrotation presenting as recurrent vomiting: a case report.

Gut malrotation is a congenital anomaly characterized by either lack of rotation or incomplete rotation of gut around axis of superior mesenteric artery. Most patients present within first year of life. Presentation during adult life is considered rare. Diagnosis of intestinal malrotation during adult life is most often by chance rather than by clinical acumen. Once diagnosed, treatment is based on the general principles of management of intestinal obstruction. We are presenting one such case in which CECT abdomen done to look for the diagnosis of acute pancreatitis leads us to the identification of intestinal malrotation.

Intestinal malrotation: a rare cause of small intestinal obstruction.

Background. The diagnosis of intestinal malrotation is established by the age of 1 year in most cases, and the condition is seldom seen in adults. In this paper, a patient with small intestinal malrotation-type intraperitoneal hernia who underwent surgery at an older age because of intestinal obstruction is presented. Case. A 73-year-old patient who presented with acute intestinal obstruction underwent surgery as treatment. Distended jejunum and ileum loops surrounded by a peritoneal sac and located between the stomach and transverse colon were determined. The terminal ileum had entered into the transverse mesocolon from the right lower part, resulting in kinking and subsequent segmentary obstruction. The obstruction was relieved, and the small intestines were placed into their normal position in the abdominal cavity. Conclusion. Small intestinal malrotations are rare causes of intestinal obstructions in adults. The appropriate treatment in these patients is placement of the intestines in their normal positions.

Malrotation beyond infancy

ObjectiveThe aim of this work was to study the various presentations of malrotation and management in patients older than 1 year. Materials and MethodsMedical records of patients operated on over the last 6 years who were older than 1 year with a diagnosis of intestinal malrotation were evaluated retrospectively. Data about age at presentation, sex, presenting symptoms, time to diagnosis, radiographic imaging performed, surgical intervention, complications, and postoperative follow-up were collected and evaluated. ResultsThe study population included 35 children and 3 adults. About three-fourths of pediatric patients were younger than 5 years, and about half of these presented in the second year of life. All patients who presented in the second year of life had a classical presentation of malrotation. Older patients presented more commonly with atypical symptoms. Of these, 5 older children were previously treated for suspected diagnosis of abdominal tuberculosis. Two patients were referred for acute pancreatitis and 1 for severe gastroesophageal reflux disease. Three adults presented with acute small intestinal obstruction and were diagnosed to have malrotation intraoperatively.Upper gastrointestinal contrast study was diagnostic of malrotation in all pediatric patients. Ultrasound and color Doppler study of the abdomen revealed abnormal relationship of the superior mesenteric artery and vein in about one-third of the patients. All patients underwent a standard Ladd procedure. Midgut volvulus was present in about one-fourth of patients. Forty percent of patients with atypical presentation had persistence of preoperative symptoms postoperatively. Two adults developed complications postoperatively. There was no mortality in the present study. ConclusionMalrotation should be suspected in all patients with varied acute or chronic abdominal symptoms, and the upper gastrointestinal contrast study should be conducted. If the existence of typical malrotation is confirmed, surgical correction is mandatory to avoid volvulus and intestinal obstruction independently of the patient's age.

704 Malrotation - Not a Laughing Matter

BackgroundEarly diagnosis and management of intestinal malrotation can potentially prevent the devastating complications associated with midgut volvulus. Atypical presentation of intestinal malrotation in older children frequently leads to a significant...

Sonographic assessment of the retroperitoneal position of the third portion of the duodenum: an indicator of normal intestinal rotation

The diagnosis of intestinal malrotation is based on an upper gastrointestinal contrast series (UGI), which is considered the imaging reference standard. It may however be challenging even for experienced paediatric radiologists. The purpose of this study was to demonstrate the agreement between UGI and US in assessing the position of the third portion of the duodenum (D3) and to show that a retroperitoneal duodenum indicates normal forgut rotation. In a prospective study, US assessment of the duodenum and the superior mesenteric vessels was performed in consecutive children who were referred for clinically indicated UGI at a single institution. Eighty-five children, 5 months to 14 years old, were studied. In 82/85 (96%), both US and UGI suggested normal forgut rotation. In three children, US demonstrated a normal position of the D3 whereas UGI showed an abnormal position of the duodeno-jejunal junction. US is a non-invasive, easily performed technique for excluding malrotation. UGI may be reserved for situations where US does not demonstrate a normal position of the D3.

Diagnosis of Intestinal Malrotation in Adults

Diagnosis of Intestinal Malrotation in Adults

Intestinal Malrotation

Complications of intestinal malrotation are familiar to pediatric surgeons but are rarely encountered by those caring strictly for adults. The aim of this study was to review our experience with disorders of intestinal rotation in adult patients and to emphasize the clinical presentation, radiographic features, and results of surgical treatment.Ten adult patients (mean age, 42 (range, 22-73) years) with complications of intestinal malrotation were identified by review of department records. Clinical presentation, operative treatment, and outcome were recorded.Nine patients presented with obstructive symptoms (five chronic and four acute). A diagnosis of malrotation was made preoperatively in all cases by a small-bowel contrast study or CT scan. Patients were treated by laparotomy with adhesiolysis (4 cases including one paraduodenal hernia and two midgut volvuli), Ladd's procedure (4 cases), or duodenopexy and cecopexy (1 case). One patient presented with an acute abdomen and was found to have appendicitis. There was no mortality. Two patients developed complications (wound infection and ileus). Two patients had recurrent episodes of small-bowel obstruction with a mean follow-up of 30 (range, 2-69) months and one required reoperation.Complications of intestinal rotation can occur in adult patients and may present with chronic or acute symptoms. Prompt recognition and surgical treatment usually lead to a successful outcome. The diagnosis of intestinal malrotation should be considered in any adult patient with signs and symptoms of small-bowel obstruction.

Intestinal malrotation: a rare but important cause of bowel obstruction in adults.

Complications of intestinal malrotation are familiar to pediatric surgeons but are rarely encountered by those caring strictly for adults. The aim of this study was to review our experience with disorders of intestinal rotation in adult patients and to emphasize the clinical presentation, radiographic features, and results of surgical treatment. Ten adult patients (mean age, 42 (range, 22-73) years) with complications of intestinal malrotation were identified by review of department records. Clinical presentation, operative treatment, and outcome were recorded. Nine patients presented with obstructive symptoms (five chronic and four acute). A diagnosis of malrotation was made preoperatively in all cases by a small-bowel contrast study or CT scan. Patients were treated by laparotomy with adhesiolysis (4 cases including one paraduodenal hernia and two midgut volvuli), Ladd's procedure (4 cases), or duodenopexy and cecopexy (1 case). One patient presented with an acute abdomen and was found to have appendicitis. There was no mortality. Two patients developed complications (wound infection and ileus). Two patients had recurrent episodes of small-bowel obstruction with a mean follow-up of 30 (range, 2-69) months and one required reoperation. Complications of intestinal rotation can occur in adult patients and may present with chronic or acute symptoms. Prompt recognition and surgical treatment usually lead to a successful outcome. The diagnosis of intestinal malrotation should be considered in any adult patient with signs and symptoms of small-bowel obstruction.

Intestinal malrotation and volvulus in infancy

Intestinal malrotation is most commenly complicated by volvulus in the first weeks of life. Early diagnosis and surgical intervention are needed to prevent gangrene of the midgut and peritonitis. When the diagnosis of intestinal malrotation is suspected, a plain X-ray film of the abdomen must be perfomed. In 4 of 21 cases we found a low intestinal obstruction, which was complicated by a high risk of intestinal gangrene and high mortality. These X-ray findings should lead to emergency surgery. If the plain X-ray film shows the “double bubble sign” (N = 14), then intestinal malrotation and volvulus as well as duodenal atresia are possible diagnosis. As both conditions require surgery, no further examinations are necessary. With a nonspecific pattern (N = 3), a barium meal should be performed in order to classify the disease type. We recommend that operation should be performed in most cases based on the findings on the plain X-ray film and that cases with low intestinal obstruction should be operated upon as emergencies.