Malrotation Of Small Bowel Research Articles

Small Bowel Volvulus as Delayed Presentation of Undiagnosed Crohn's Disease: A Case Report.

IntroductionEmergency department (ED) visits related to flare-ups of inflammatory bowel disease (IBD) are becoming more prevalent. There are many potentially dangerous complications and sequelae of uncontrolled IBD.Case ReportWe report a case of a middle-aged woman who presented with a few hours of severe abdominal pain, nausea, and vomiting. Given her hemodynamic instability, she was sent urgently for computed tomography, which showed an incomplete small bowel malrotation, mesenteric volvulus, and high-grade small bowel obstruction with evolving ischemia. The patient underwent exploratory laparotomy to resect most of her small intestines. Biopsies later revealed active Crohn’s disease.ConclusionPatients with flare-ups of IBD are common in the ED, but very few present with a midgut volvulus later in life. Our case is unique and adds to the literature due to the dramatic consequences of undiagnosed Crohn’s disease in a patient with intermittent symptoms and extensive workup spanning over two decades.

Malrotation of Small Bowel with Midgut Volvulus in a COVID-19 Positive Young Male: A Rare Case Report

Malrotation of small bowel with midgut volvulus has a very low incidence of 0.2% in adults. Symptomatic malrotation in neonates occur in one in 6000 live births. The normal 270 degrees counter-clockwise gut rotation around the axis of superior mesenteric artery is absent in such cases. A 20-year-old male presented with intermittent colicky abdominal pain since four to five months, post-prandial bilious vomiting since one week and obstipation since two days. He also had difficulty breathing since two days. Abdominal examination revealed vague lump in right lower abdomen with no signs of peritonitis. Radiological investigations Ultrasonography (USG) and Contrast Enhanced Computed Tomography (CECT) abdomen demonstrated over distended stomach with dilated D1 and D2 showing changes in relation to superior mesenteric artery and superior mesenteric vein with rotation of mesentery in whirlpool pattern. His Reverse Transcriptase-Polymerase Chain Reaction Test (RT-PCR) was positive for Coronavirus Disease-2019 (COVID-19). Conservative trial for two days was followed by surgical exploration which revealed gut malrotation with mid-gut volvulus. Ladd’s procedure was performed. Malrotation with midgut volvulus is an acute surgical emergency that demands high index of suspicion in an adult. Associated COVID-19 pneumonia can increase mortality. Patient was followed-up after three weeks with fruitful results, proving that an early diagnosis and definitive surgical correction of malrotation with midgut volvulus is essential.

Diagnostic Conundrum in Intestinal Obstruction; Malrotation in Elderly

Congenital intestinal malrotation is an anomaly of intestinal rotation and fixation which occurs during fetal development. It is rare for a malrotation to be present in adulthood. Indeed, most adult patients are asymptomatic and are later discovered incidentally during operation for other clinical conditions. Here we presented a case of malrotation in a 79-year-old elderly man presented with intermittent colicky abdominal pain, obstipation and vomiting for 2 days. Abdominal examination revealed distended abdomen, tenderness at right upper abdominal quadrant and peritonism. A contrast-enhanced computed tomography scan of the abdomen showed small bowel malrotation with suspected volvulus. The patient underwent exploratory laparotomy in which the intraoperative findings were small bowel malrotation, tight Ladd's band and midgut volvulus on top of perforated gallbladder empyema. The patient also underwent cholecystectomy, release of Ladd's band, re-rotation of the bowel, fixation of caecum to the left lower quadrant and appendicectomy. A complete recovery and relief of gastrointestinal symptoms were achieved postoperatively.

A case of midgut malrotation in an adult male causing volvulus and subacute intestinal obstruction

Small bowel malrotation is a congenital disorder of midgut rotation usually encountered in paediatric age group. Here is a case report of small bowel sub-acute obstruction due to midgut volvulus precipitated by malrotation. The incidence of microtonal presentation in adults is 0.2%, making this case a rarity. This patient presented with chronic vague symptoms like dyspepsia, diffuse low-grade abdominal pain, non-projectile vomiting which were on and off for 4 to 5 years since he presented to us. Furthermore because of the remitting nature of his symptoms, these symptoms usually pointed out to a more benign ailment, so unless we do a more elaborate study like computed tomography, we might miss the diagnosis. This case report emphasis the wide range of presenting age for certain congenital disorders like malrotation of gut.

Malrotation of Small Bowel-Diagnostic Computed Tomography (CT) Signs and Intraoperative Findings.

Right paraduodenal hernia usually occurs in setting of nonrotated small bowel, when small bowel herniates through Waldeyer's fossa (a defect in the first part of jejunal mesentery). It lies behind the superior mesenteric artery and inferior to the transverse colon or third portion of duodenum. We studied two cases of right paraduodenal hernia, an incomplete rotation, and nonrotation of small bowel, respectively, and describe CT abdomen signs, which can give a preoperative diagnosis.

Agenesis of the dorsal mesentery presenting in an adolescent

Agenesis of the dorsal mesentery is a rare occurrence that usually presents in children. It is associated with proximal small bowel malrotation as well as high jejunal atresia with discontinuity of the small bowel. We present a case report of an adolescent presenting with clinical features of proximal small bowel obstruction (confirmed on imaging) as well as acute pancreatitis. At laparotomy, he was found to have no dorsal mesentery, without small bowel atresia, and the duodenum was fixed to the posterior abdominal wall. The patient recovered well and remained symptom-free.

Agenesis of the dorsal mesentery presenting in an adolescent

Agenesis of the dorsal mesentery is a rare occurrence that usually presents in children. It is associated with proximal small bowel malrotation as well as high jejunal atresia with discontinuity of the small bowel. We present a case report of an adolescent presenting with clinical features of proximal small bowel obstruction (confirmed on imaging) as well as acute pancreatitis. At laparotomy, he was found to have no dorsal mesentery, without small bowel atresia, and the duodenum was fixed to the posterior abdominal wall. The patient recovered well and remained symptom-free.

Antenatal sonographic features of ileal atresia

The purpose of this study was to determine the antenatal sonographic features of ileal atresia. We identified neonates with surgically-confirmed ileal atresia who had antenatal sonography performed in our institution between 1 January 1999 and 30 June 2009. The antenatal sonography images and reports were reviewed. Sixteen neonates had surgically-confirmed ileal atresia in our institution in 11 years. Seven fetuses (43.7%) did not have any intestinal abnormalities detected antenatally on ultrasonography. Nine fetuses (56.3%) had various sonographic features of ileal atresia, including multiple dilated bowel loops, ascites, cysts, and polyhydramnios with or without associated anomalies. Six of nine fetuses had multiple dilated bowel loops and two fetuses had ascites. One fetus had a large, cystic, mixed, echogenic dilatation of bowel. Polyhydramnios was present in three fetuses. Heart anomalies, kidney anomalies, or hydrops were present in four fetuses. Eight of 16 fetuses (50%) had other intestinal problems, including intussusceptions in one fetus, small bowel malrotation, meconium pseudocyst volvulus, meconium peritonitis, and a congenital band. The prenatal sonographic features of ileal atresia are not simple. Various sonographic findings are shown and ileal atresia was detected in about 60% of cases.

Midgut volvulus in a 4-year-old male

A 4 year-old boy presented with sudden, intense, and constant abdominal pain that awoke him from sleep. He had experienced no nausea or vomiting, and stooling had been regular. Vital signs were blood pressure: 133/87, heart rate: 120, respiratory rate: 28, SaO2: 99%, and temperature: 35.7. On physical exam the patient was writhing in pain with a mildly distended abdomen, with bowel sounds present and guaiac negative stool. Laboratory studies revealed a white blood cell count of 28,000. Abdominal x-ray revealed findings compatible with small bowel obstruction (Figs. 1, ​,2,2, ​,3),3), and subsequent upper GI series raised suspicion for midgut volvulus (Figs. 4, ​,5).5). The patient received IV fluids and morphine, and was emergently taken to the operating room. Fig. 1 Supine abdomen showing small bowel obstruction Fig. 2 Erect abdomen showing air-fluid levels Fig. 3 Decubitus abdomen showing air-fluid levels Fig. 4 Anteroposterior upper GI image showing volvulus Fig. 5 Lateral upper GI image showing volvulus Midgut volvulus is a life-threatening complication caused by small bowel malrotation that leads to obstruction and ischemia. About 75% of all midgut volvulus cases occur within the 1st year of life, the majority of which are in the 1st month [1]. The classic presentation is a newborn infant with bilious vomiting. Older children tend to present with a history of intermittent vomiting, chronic diarrhea, and vague abdominal pain, often leading to multiple hospital admissions with signs of malnourishment [2]. Abdominal x-ray can be useful in identifying small bowel obstruction. Upper gastrointestinal series is the diagnostic tool of choice, with the “corkscrew sign” often identified as an indicator of midgut volvulus [3]. Midgut volvulus is a surgical emergency that can quickly lead to bowel necrosis, sepsis, and death. Prompt diagnosis is therefore crucial for these patients. The treatment of choice is Ladd’s procedure.

Meconium peritonitis: prenatal diagnosis and postnatal outcome

Objective: To detect meconium peritonitis for the fetal period is important for prenatal counseling. The aim of this study was to evaluate prenatal ultrasound finding for diagnosing meconium peritonitis and postnatal clinical course and outcomes. Methods: The prenatal and postnatal medical records of all patients to our institutions with confirmed meconium peritonitis were reviewed, with emphasis on prenatal ultrasound findings, postnatal investigations, operative findings, outcomes of meconium peritonitis. Results: Fourteen fetuses were confirmed to have meconium peritonitis at birth by operation. Eight cases were diagnosed correctly because of prenatal ultrasound showing ascites and calcification/dilated or hyperechoic bowel loops. In the other 6 cases, prenatal ultrasound showed only ascites. One patient was operated on first day of life and its intra-operative finding was malrotation of small bowel, volvulus with strangulation, perforation and jejunal atresia. Most cases were operated on 2nd or 3rd day of life. Intra-operative findings were ileal atresia and perforation in 11 cases and jejunal atresia and perforation in 3 cases. Four patients underwent ileostomy but all patients survived and prospered. Conclusion: All patients do not present typical prenatal ultrasound findings of meconium peritonitis. Therefore, even in pregnancies associated with isolated ascites, meconium peritonitis should be taken into consideration. Favorable outcome of intrauterine meconium peritonitis is reassuring in prenatal counselling and stems from multidisplinary team approach.

De NovoPericentric Inversion of Chromosome 9 in Congenital Anomaly

PurposeThe pericentric inversion of chromosome 9 is one of the most common structural balanced chromosomal variations and has been found in both normal populations and patients with various abnormal phenotypes and diseases. The aim of this study was to re-evaluate the clinical impact of inv(9)(p11q13).Materials and MethodsWe studied the karyotypes of 431 neonates with congenital anomalies at the Pediatric Clinic in Ajou University Hospital between 2004 and 2008 and retrospectively reviewed their clinical data.ResultsChromosomal aberrations were detected in 60 patients (13.9%). The most common type of structural abnormality was inv(9)(p11q13), found in eight patients. Clinical investigation revealed that all eight cases with inv(9)(p11q13) had various congenital anomalies including: polydactyly, club foot, microtia, deafness, asymmetric face, giant Meckel's diverticulum, duodenal diaphragm, small bowel malrotation, pulmonary stenosis, cardiomyopathy, arrhythmia, and intrauterine growth restriction. The cytogenetic analysis of parents showed that all of the cases were de novo heterozygous inv(9)(p11q13).ConclusionSince our results indicate that the incidence of inv(9)(p11q13) in patients with congenital anomalies was not significantly different from the normal population, inv(9)(p11q13) does not appear to be pathogenic with regard to the congenital anomalies. Some other, to date unknown, causes of the anomalies remain to be identified.

Precipitous decline of gravid patient with congenital small bowel malrotation

Congenital small bowel malrotation is an uncommon cause of ischemic bowel. There are only a few case reports highlighting this condition in gravid patients. We report a 33-year-old primigravida at 27 weeks who presented to the emergency department with diffuse abdominal pain. Although initially stable, she experienced a rapid calamitous decline. On laparatomy she was diagnosed with congenital small bowel malrotation. Intraabdominal catastrophes must always be considered as a possible etiology of nonobstetrical abdominal pain in pregnant women.

A Case Report of Gastric Perforation and Peritonitis Associated With Opportunistic Infection bySarcina ventriculi

Case 1 A 14-year-old boy presented at the emergency room with sudden onset abdominal pain and distention. One and a half months prior to admission, the patient had a history of bowel reduction secondary to malrotation of small bowel. A concomitant appendectomy was also performed. Radiographic study revealed pneumoperitoneum. The patient underwent exploratory laparotomy. Intraoperative findings revealed gastric perforation and necrotic stomach involving the fundus and greater curvature. There was gross contamination of the abdominal cavity by food and blackening of the abdominal viscera. The inferior pole of the spleen had a small infarct. About 600 mL serosanguinous abdominal fluid was aspirated and submitted for culture and sensitivity. The stomach was massively dilated. The omentum along the greater curvature was necrotic and friable.

Persistent value of air‐augmented radiograph in neonatal high gastrointestinal obstruction, despite more modern techniques

Air is a safe and effective natural contrast agent in neonatal high gastrointestinal (GIT) obstruction. Successful early decompression often results in plain abdominal radiographs of low diagnostic yield. We present a series of neonates with high GIT obstruction in whom air‐augmented abdominal radiographs (AAAR) were performed instead. Fourteen neonates presented with suspected high GIT obstruction. In 12 sick babies, obstruction was confirmed and the level of obstruction was determined. The other two neonates required additional positive contrast upper GIT studies. These confirmed small bowel malrotation. For neonatal high GIT obstruction an AAAR can provide a rapid and accurate diagnosis. Positive contrast agent studies should be performed when the AAAR is non‐diagnostic.

CT appearance of midgut volvulus with malrotation in a young infant

Computed tomography (CT) appearances of small bowel malrotation and midgut volvulus (MGV) have rarely been described in paediatric patients. We present spiral CT images of a surgically proven case in a young infant. The literature on imaging techniques to diagnose these conditions is reviewed. Radiation doses of upper gastrointestinal series (UGI) and spiral CT are estimated and compared.

Persistent value of air-augmented radiograph in neonatal high gastrointestinal obstruction, despite more modern techniques

Air is a safe and effective natural contrast agent in neonatal high gastrointestinal (GIT) obstruction. Successful early decompression often results in plain abdominal radiographs of low diagnostic yield. We present a series of neonates with high GIT obstruction in whom air-augmented abdominal radiographs (AAAR) were performed instead. Fourteen neonates presented with suspected high GIT obstruction. In 12 sick babies, obstruction was confirmed and the level of obstruction was determined. The other two neonates required additional positive contrast upper GIT studies. These confirmed small bowel malrotation. For neonatal high GIT obstruction an AAAR can provide a rapid and accurate diagnosis. Positive contrast agent studies should be performed when the AAAR is non-diagnostic.

CASE REPORT: Idiopathic localized dilatation of the ileum. A rare cause of gastrointestinal haemorrhage in an adult

A case of idiopathic localized dilatation of the ileum presenting in adulthood and associated with small bowel malrotation, ulceration and bleeding is described. To our knowledge, this is the first such report of this combination of features. The diagnosis was made using a small bowel barium study and intra-operative enteroscopy. Idiopathic localized dilatation of the ileum with ulceration should be considered as a rare small intestinal cause of occult or frank gastrointestinal blood loss in children or young adults.

CASE REPORT: Idiopathic localized dilatation of the ileum. A rare cause of gastrointestinal haemorrhage in an adult

A case of idiopathic localized dilatation of the ileum presenting in adulthood and associated with small bowel malrotation, ulceration and bleeding is described. To our knowledge, this is the first such report of this combination of features. The diagnosis was made using a small bowel barium study and intra-operative enteroscopy. Idiopathic localized dilatation of the ileum with ulceration should be considered as a rare small intestinal cause of occult or frank gastrointestinal blood loss in children or young adults.

Retrogastric colon: CT demonstration of anatomic variations.

In a series of 9,400 body computed tomographic (CT) scans of adult patients, a retrogastric course of the transverse colon with interposition of colon between the pancreatic body-tail and stomach was identified in 18 patients (0.2%). Three other patients (0.03%) had retrosplenic, retrogastric colon with transverse colon interposed between the spleen and posterior diaphragm. Three of the 18 patients with pancreaticogastric interposition also had small bowel malrotation. Clinically, no symptoms attributable to retrogastric colon were found. Retrogastric colons probably result from mild embryologic abnormalities of bowel rotation and fixation. Radiologically, colon in the area of the lesser sac must be differentiated from the normal duodenojejunal flexure, a perforated viscus, and abscess.

Fraser syndrome: Cryptophthalmos with small bowel malrotation : P. Woodhead and C. Hall. Clin Radiol 42:362–363, (November), 1990

Fraser syndrome: Cryptophthalmos with small bowel malrotation : P. Woodhead and C. Hall. Clin Radiol 42:362–363, (November), 1990