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Duodenal Obstruction in Down’s Syndrome Due to Malrotation and Duodenal Web
Shehzad Huda,Teresa Rivera-Penera
Journal of Gastroenterology and Hepatology Research , 2012, DOI: 10.6051/j.issn.2224-3992.2012.01.046
Abstract: This case reports on a child with Down’s syndrome who had initialpresentation of intestinal obstruction due to malrotation for whichshe went through correction via laprotomy and later found to haveduodenal web with persistent vomiting after correction of themalrotation.
Carcinoma of the Colon in an Adult with Intestinal Malrotation  [PDF]
Michael Donaire,James Mariadason,Daniel Stephens,Sitaram Pillarisetty,Marc K. Wallack
Case Reports in Surgery , 2013, DOI: 10.1155/2013/525081
Abstract: Colon cancer is the third most common cancer in the USA. Intestinal malrotation diagnosed in adulthood was, until recently, a very rare phenomenon. While patients may present with intestinal obstruction or abdominal pain, the diagnosis is now often made as an incidental finding by computed tomography (CT). Surprisingly we found only seven case reports of carcinoma of the colon in patients with malrotation; CT failed to make the preoperative diagnosis in a majority. Laparoscopic colon surgery is rapidly becoming standard of care for colon cancer. We present a case of carcinoma of the colon in an adult that thwarted attempts at laparoscopic resection due to failure to recognize malrotation preoperatively. The literature is reviewed, and the implications of malrotation in patients with colon cancer are examined. 1. Introduction Intestinal malrotation is a congenital anomaly that generally presents in the first month of life. Until a spate of recent reports, adult malrotation was considered extremely rare. Carcinoma of the colon, on the other hand, is the second most common cancer. Surprisingly reports of carcinoma of the colon in adults with malrotation are so rare that we found only 7 case reports in the literature. We present our case and discuss the implications. 2. Case Report A 52-year-old male was admitted to an outside institution with lethargy, weight loss of 30?kg, and severe unexplained anemia (hemoglobin 4.5?g/dL; hematocrit 15%). The patient felt better after transfusion of 4 units of packed red blood cells, and gastroscopy performed at the time revealed a healed duodenal ulcer and erosive gastritis. When he lost his medical insurance, he was discharged and advised to have further workup performed elsewhere. During a difficult colonoscopy at a charity clinic, a large tumor was found in his right colon that precluded passage of the scope to the cecum (see Figure 1). Biopsy confirmed an infiltrating adenocarcinoma. Polyps in the sigmoid and transverse colon were also removed and found to be tubular adenomata. The patient was then referred to our institution, a safety-net hospital, where a CT scan was performed. The imaging demonstrated a ?cm mass in the mesentery with spiculated calcifications, as well as an additional mass near the ileocecal valve that had the appearance of an intussusception (see Figure 2). Malrotation was not suspected, although later review of the imaging with a specialized CT radiologist demonstrated inversion of the normal SMA to SMV configuration (see Figure 3). Malrotation was not suspected. The liver was free of
A Huge Epiglottic Cyst Causing Airway Obstruction in an Adult  [PDF]
Tuan-Jen Fang,Ka-Shun Cheng,Hsueh-Yu Li
Chang Gung Medical Journal , 2002,
Abstract: An epiglottic cyst causing airway obstruction is rare in an adult. Early definitive diagnosisand management obviate an unnecessary tracheostomy. We report a case of a 64-yearoldwoman who arrived at our hospital with progressive stridor and foreign body sensationwhen swallowing for 6 weeks. A hot potato voice and biphasic stridor were remarkableupon physical examination. Indirect mirror and fibroscopic examination revealed a hugeepiglottic cyst. The neck lateral X-ray and computed tomography scan demonstrated a hugecystic mass over the epiglottis. A 2.5 3.0 cm cystic mass was removed with endoscopicCO2 laser after needle decompression. The patient was discharged on the third day aftersurgery without complications. An epiglottic cyst in an adult seldom causes upper airwayobstruction and is easily ignored by clinicians. We emphasize that complete airway evaluationincluding routine check-up of the larynx is mandatory for patients with intractableobstructive airway disease. Endoscopic laser surgery is effective in the surgical removal ofan epiglottic cyst.
Duodenal duplication cyst and pancreas divisum causing acute pancreatitis in an adult male  [cached]
Eduardo Redondo-Cerezo,Julio Pleguezuelo-Díaz,Mercedes López de Hierro,José F Macias-Sánchez
World Journal of Gastrointestinal Endoscopy , 2010,
Abstract: Duodenal duplication cysts are rare congenital abnormalities which are more commonly diagnosed in infancy and childhood. However, in rare cases, these lesions can remain asymptomatic until adulthood. The combination of duplication cyst and pancreas divisum is extremely rare and both conditions have been linked with acute recurrent pancreatitis. We present the case of a 37 years-old patient who presented with repeated episodes of acute pancreatitis. By means of magnetic resonance imaging and endoscopic ultrasonography we discovered a duplication cyst whose cavity received drainage from the dorsal pancreas. After opening the cyst cavity to the duodenal lumen with a needle knife the patient presented no further episodes in the clinical follow-up. Comparable literature findings and therapeutic options for these abnormalities are discussed with regard to the presented case.
Yogesh Kumar Sarin,Akshay Sharma,Shalini Sinha,Vidyanand Pramod Deshpande
Journal of Neonatal Surgery , 2012,
Abstract: Aim: To describe the management and outcome of patients with duodenal webs, managed over a period of 12 years in our unit.Methods: It is a retrospective case series of 18 patients with congenital duodenal webs, managed in our unit, between 1999 and 2011. The medical record of these patients was retrieved and analyzed for demographic details, clinical presentation, associated anomalies, and outcome. Results: The median age of presentation was 8 days (range 1 day to 1.5 years). Antenatal diagnosis was made in only 2 (11.1%) patients. The commonest presentation was bilious vomiting. Associated anomalies were present in 8/18 patients, common being malrotation of gut. Down’s syndrome was seen in 2 patients and congenital heart disease in 1 patient. One patient had double duodenal webs. There was a delay in presentation of more than 5 days of life in 11/18 (61%) patients. Three patients who presented beyond neonatal age group had fenestrated duodenal membranes causing partial obstruction. In addition, the diagnosis was missed in patients operated for malrotation elsewhere (n=2), imperforate anus (n=2) and esophageal atresia with tracheo-esophageal fistula (n=1). A lateral duodenotomy with excision of the obstructive membrane was done in all patients. A trans-anastomotic tube (TAT) for enteral feeding was used in 8 patients The mortality rate was 4/18 (22%); the main causes being sepsis, prematurity, very low birth weight and associated congenital anomalies. The mean hospital stay for the 14 survivors was 18 days. Total parental nutrition (TPN) was not given to any patient.Conclusions: Congenital duodenal webs are different as the diagnosis is often missed especially in case of perforated webs. Outcome depends upon the time of presentation and associated anomalies. The use of TAT feeding for nutritional support is an easy alternative to TPN.
Late Presentation of a Congenital Intrinsic Duodenal Obstruction in a Patient with Anorectal Malformation  [PDF]
Parkash Mandhan, Kirtikumar J. Rathod, Dilip Sankhla
Surgical Science (SS) , 2013, DOI: 10.4236/ss.2013.47065

Anorectal Malformations are known to be associated with various other congenital anomalies including duodenal atresia. An association of congenital intrinsic duodenal obstruction causing partial duodenal obstruction in a patient with anorectal malformation is not described in literature. We describe a case of delayed presentation of congenital intrinsic duodenal obstruction in a child with high-type anorectal malformations causing diagnostic dilemma.

Midgut malrotation first presenting as acute bowel obstruction in adulthood: a case report and literature review
Okiemute F Emanuwa, Abraham A Ayantunde, Tony W Davies
World Journal of Emergency Surgery , 2011, DOI: 10.1186/1749-7922-6-22
Abstract: A review of the literature is presented to highlight the rarity of intestinal malrotation and the controversies surrounding its management in the adult population.Midgut malrotation is a congenital anomaly in the embryological development of the foetal intestinal rotation. It has been estimated that it affects approximately 1 in 500 live births [1]. However, the true incidence is difficult to determine as a substantial number of cases will go undetected throughout life. The vast majority of the complications associated with midgut malrotation present in the first month of life and 60-85% of cases are diagnosed in this age group [1,2]. It is reported that more than 90% of patients will present by the time of their first birthday [3]. Adult midgut malrotation is very rare and its incidence has been reported to be between 0.0001% and 0.19% [3,4]. Most adult diagnoses of midgut malrotation are made in asymptomatic patients; either on imaging investigations for unrelated conditions or at operations for other pathology. This scenario of incidental diagnosis is becoming increasingly common, particularly with improvements, and increased use, of diagnostic imaging techniques in modern practice. However, there are a small proportion of affected adults who may present with acute or chronic symptoms of intestinal obstruction or intermittent and recurrent abdominal pain. The true diagnosis in this age group is fraught with immense difficulty, especially because the typical presentation is with non-specific symptoms and the fact that adult Surgeons usually have low index of suspicion and may not consider the diagnosis a possibility in the initial evaluation of adult patients with abdominal pain.We report a case of an adult patient with an acute presentation of midgut malrotation which highlights the dilemmas of preoperative diagnosis, as supported by a review of the literature.A 55-year old gentleman was admitted to the Accident and Emergency department with a three day history o
H. Nahvi Z. Khorgami
Acta Medica Iranica , 2008,
Abstract: Midgut malrotation is typically presented during the first few months of life but sometimes may encounter later in life, causing difficulties and mistakes in diagnosis. We reviewed records of eleven rare patients with midgut malrotation older than one year of age and extracted their clinical and paraclinical data. The most common presenting symptoms were bilious vomiting, recurrent abdominal pain and constipation. Five of eleven patients had presented from neonatal period. The average interval between first symptoms and surgical correction of malrotation was about 22 months. Some of the patients had been undergone false treatments. Most cases were diagnosed by contrast studies (upper gastrointestinal series and barium enema). Diagnosing midgut malrotation in older children is often delayed. This anomaly should be suspected in all children with signs and symptoms of small bowel obstruction, chronic abdominal pain and vague abdominal discomfort and in all patients of any age with abdominal discomfort who do not respond to other therapies. Contrast studies may be necessary to rule out malrotation in suspected patients.
Congenital Intestinal Malrotation as the Serious Cause of Neonatal Intestinal Obstruction
H Nahvi,J Ahmadi,M Kalantari,M Molaeian
Iranian Journal of Pediatrics , 2005,
Abstract: Background: Congenital intestinal malrotation as an abnormal embryonic intestinal rotation and fixation leads to various clinical presentations of high complete or incomplete intestinal obstruction, especially midgut volvulus and extensive intestinal loss that may cause short bowel syndrome or death of the patient. we conducted this study to assay clinical presentations, surgical findings, mode of management and outcome of neonates with intestinal malrotation. Methods: We studied retrospectively data of 25 neonates with intestinal malrotation in 3 hospitals of the Tehran University of Medical Sciences (1985-2003). Results: Patients consisted of 17 males and 8 females. 5 (24%) patients had extensive intestinal gangrene that resulted in short bowel syndrome in 2 patients. 7 (20%) patients died, 5 of them due to intestinal volvolus and 2 other due to associated anomalies and sepsis. Most common clinical signs and symptoms were vomitus (96%), bilious vomiting (80%), constipation (24%),), coliky abdominal pain (23%). Abdominal distention was observed only in patients with volvolus (38%). Obstipation (31%) and rectorragia were seen only in patients with volvolus and intestinal gangrene. 28% of neonates had associated anomalies. Malrotion was suggested by abdominal X-ray in 3 out of 12 (25%), barium enema in 9 out of 11 (81.8%), and gastrointestinal follow through in 3 out of 4 (75%) examinations. 3 patients were surgically managed according to only one abdominal X-ray. Ladd procedure was performed in all patients and other necessary corrective operations for associated anomalies included intestinal resection with anastomisis in 5 and intestinal resection with entrostomy in 2 cases. Conclusion: To prevent extensive intestinal loss due to intestinal volvolus in neonates with abrupt bilious vomiting, malrotation must be excluded, and if a volvulus is suspected, emergency laparotomy should be undertaken.
Duodenal obstruction after successful embolization for duodenal diverticular hemorrhage: A case report  [cached]
Yu Jin Kwon, Ji Hun Kim, Seung Hyoung Kim, Bong Soo Kim, Heung Up Kim, Eun Kwang Choi, In Ho Jeong
World Journal of Gastroenterology , 2009,
Abstract: We present a 69-year-old woman with a duodenal obstruction after successful selective transcatheter arterial embolization (TAE) for a duodenal diverticular hemorrhage. Two weeks after TAE, the patient showed abrupt symptoms of duodenal obstruction. Resolving hematomas after successful selective transcatheter arterial embolization should be thoroughly observed because they might result in duodenal fibrotic encasement featuring inflammatory duodenal wall thickening, duodenal deformity, dysmotility, and finally obstruction.
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