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Intestinal malrotation as a cause for abdominal pain in adults
Federico Guillermo Lubinus Badillo,Sandra Patricia Rojas Rueda,Carlos Julio Salcedo Hernández
MedUNAB , 2006,
Abstract: We show the case of a 63 year old woman complaining of chronicabdominal pain and bilious vomiting. The patient was admitted tothe hospital with a diagnosis of intestinal obstruction which got better by medical treatment. After performing an abdominal computarized tomography, a midgut volvulus was diagnosed and later confirmed by an intestinal transit time. The patient was discharged with out symptoms after medical treatment and an elective procedure was scheduled (Ladd procedure) and to reduce the risk of volvulusand intestinal ischemia. We discuss the clinical presentation of thedisease, the diagnostic methods used and the treatment optionsavailable.
Malrotación intestinal en adultos: causa infrecuente de abdomen agudo oclusivo Intestinal malrotation in adults: infrecuent cause of acute oclusive syndrome
Josefina Etchevers,Mariano Palermo,María Gabriela Salvatore,Francisco Tarsitano
Revista Argentina de Radiología , 2008,
Abstract: El 90 % de los casos de obstrucción por malrotación intestinal ocurre en ni os menores de 1 a o de edad, siendo altamente infrecuente en adultos. Un paciente de sexo masculino, de 31 a os de edad, con antecedente de episodios de dolor abdominal, vómitos y constipación que alternaban con períodos de normalidad desde la ni ez es admitido en el hospital por sintomatología similar, la que no cede. Luego de estudios radiológicos y de laboratorio se decide su intervención quirúrgica con el diagnóstico de obstrucción intestinal. El diagnóstico intraoperatorio realizado fue de malrotación intestinal tipo I, practicándose la operación de Ladd. La evolución del paciente es favorable. La infrecuente presentación de esta patología en adultos es lo que motiva la presentación del caso. The 90 % of the bowel obstruction caused by intestinal malrotation occurred in children younger than 1 year, this type of obstruction is very uncommon in adults. This is a male of 31 years old, with history of abdominal pain, vomits and constipation since he was a child. These symptoms were sporadical, he didn't need any surgical treatment. Recently he was admitted in our institution presenting similar symptoms, without remission of them. After imaging and laboratory studies, was performed a surgery, and the intraoperatoty diagnosis was intestinal malrotation type I. The surgical treatment was the Ladd Operation. The postsurgery evolution was good. Discharged 4 days after the surgery. The aim of this article is to present a rare case of intestinal obstruction in adults caused for an intestinal malrotation.
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
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.
Abdominoscrotal Hydrocele with Intestinal Malrotation: A Rare Association  [PDF]
Sonal Jain,Ragini Singh,Surendra Kumar Singh,Vikram Singh,Kumar Shantanu
Case Reports in Radiology , 2012, DOI: 10.1155/2012/354514
Abstract: Abdominoscrotal hydrocele is an uncommon clinical entity and so is intestinal malrotation. We report a case of 15 year old boy who presented with lump in abdomen previously diagnosed as mesenteric cyst on ultrasound. A multislice CT scan and repeat ultrasound not only diagnosed the case as abdominoscrotal hydrocele but also detected intestinal malrotation with positive whirl sign. This is the first reported case of abdominoscrotal hydrocele with intestinal malrotation. 1. Background Abdominoscrotal hydrocele (ASH) is an uncommon clinical entity, accounting for only 0.17% of all types of hydrocele [1]. ASH presents as a dumbbell-shaped giant hydrocele that occupies the scrotum and extends into the abdominal cavity through the inguinal ring. The incidence of intestinal malrotation is 1 in 500 [2]. Malrotation is defined as any deviation from the normal 270° counterclockwise rotation of the bowel that occurs during embryogenesis. The resultant-shortened mesenteric pedicle predisposes to midgut volvulus, a clockwise rotation around the superior mesenteric artery axis that can lead to bowel ischemia. This is the first reported case of ASH associated with intestinal malrotation. 2. Case Presentation A 15-year-old boy came to the department of radiodiagnosis at our institute with the requisition for computed tomography (CT). The patient had history of lower abdominal swelling for the past one year, associated with a dull dragging pain. He had no history of fever or trauma. Ultrasound examination, performed elsewhere, showed a large cystic anechoic lesion in lower abdominal cavity suggesting mesenteric cyst. On clinical examination, there was a mildly tender, soft lump in the right iliac fossa and hypogastric region measuring approximately 3 × 3?cm in size. There was no associated rise of local temperature. Multislice contrast-enhanced CT scan was done on Philips Brilliance TMCT scanner. A large cystic lesion of thin fluid attenuation was seen in right iliac fossa and lumbar region extending up to the umbilical region (Figures 1(a) and 1(b)). The lesion was extending into the right scrotal sac through the inguinal canal suggesting an abdominoscrotal hydrocele. Undescended right testis was seen, located within the inguinal canal in the region of superficial inguinal ring. A small hydrocele was also noted on the left side. Figure 1: (a) and (b) Coronal and sagittal postcontrast CT images showing a large cystic lesion of thin fluid attenuation in right iliac fossa and lumbar region extending into right scrotal sac. Right testis is located in the right inguinal
Intestinal Malrotation: Case Report
F. Carini,G. Cocorullo,G. Venza,C. Lo Piccolo,V. Valenza
Research Journal of Biological Sciences , 2012, DOI: 10.3923/rjbsci.2011.252.256
Abstract: Intestinal malrotation is a malformation characterized by an anomaly in the rotation of the midgut around the axis of the superior mesenteric artery. Its diagnosis is difficult, given the rarity of the illness and the aspecificity and variability of the symptoms as in the case researchers have examined where the symptomatology was characterized by painful colic paroxysms together with closed bowels which passed spontaneously. A correct diagnostic-therapeutic approach together with a strong suspicion is therefore, fundamental for a complete resolution of the clinical picture. In the diagnostic investigation, the gold-standard is represented by a small intestine enema. Therapy is surgical and involves the Ladd technique.
Abdominoscrotal Hydrocele with Intestinal Malrotation: A Rare Association
Sonal Jain,Ragini Singh,Surendra Kumar Singh,Vikram Singh,Kumar Shantanu
Case Reports in Radiology , 2012, DOI: 10.1155/2012/354514
Abstract: Abdominoscrotal hydrocele is an uncommon clinical entity and so is intestinal malrotation. We report a case of 15 year old boy who presented with lump in abdomen previously diagnosed as mesenteric cyst on ultrasound. A multislice CT scan and repeat ultrasound not only diagnosed the case as abdominoscrotal hydrocele but also detected intestinal malrotation with positive whirl sign. This is the first reported case of abdominoscrotal hydrocele with intestinal malrotation.
Duplicidad intestinal en el adulto joven como causa de tumor abdominal recurrente
Rivero León,Armando; Nu?ez Calatayud,Margis; Cordero Jiménez,Claudio; Armas Darias,Juan Carlos; Hernández Liven,José Antonio; Valdés Alvarez,Filiberto;
Revista Colombiana de Gastroenterologia , 2003,
Abstract: a white male patient is reported, of 21 years of age with an intestinal duplication clerk of transverse colon, uncommon digestive malformation never before reported in our hospital. the clinical study and the carried out complementary exams those are shown that included, humorales, contrasted x-rays of colon, abdominal ultrasonography, laparoscopy, and the laparotomy. we describe the opposing malformation, the surgical technique employed and the histopathological conclusions of the extracted piece, the clinical evolution, and the complications. after 43 days he was discharged with ambulatory treatment, evolving favorably. the histopathological conclusions were: intestinal duplication clerk of the transverse colon. at present he is completely cured. a revision of the literature is carried out and the approaches of more interest are exposed.
Duplicidad intestinal en el adulto joven como causa de tumor abdominal recurrente
Armando Rivero León,Margis Nu?ez Calatayud,Claudio Cordero Jiménez,Juan Carlos Armas Darias
Revista Colombiana de Gastroenterologia , 2003,
Abstract: Se presenta un paciente masculino, blanco, de 21 a os de edad con una duplicidad intestinal dependiente de colon transverso, malformación digestiva infrecuente nunca antes reportada en nuestro hospital. Se muestran el estudio clínico y los exámenes complementarios realizados, los que incluyeron, humorales, radiografías de colon por enemas, ecografía abdominal, laparoscopia y la laparotomía. Describimos la malformación encontrada, la técnica quirúrgica empleada y el estudio anatomopatológico de la pieza extraída, la evolución clínica, y las complicaciones aparecidas. A los 43 días fue dado de alta con tratamiento ambulatorio, evolucionando favorablemente. El resultado anatomopatológico fue: Duplicidad intestinal dependiente del colon transverso. Fue egresado vivo y se encuentra totalmente curado. Se realiza una revisión de la literatura y se exponen los criterios de mayor interés. A white male patient is reported, of 21 years of age with an intestinal duplication clerk of transverse colon, uncommon digestive malformation never before reported in our hospital. The clinical study and the carried out complementary exams those are shown that included, humorales, contrasted X-rays of colon, abdominal ultrasonography, laparoscopy, and the laparotomy. We describe the opposing malformation, the surgical technique employed and the histopathological conclusions of the extracted piece, the clinical evolution, and the complications. After 43 days he was discharged with ambulatory treatment, evolving favorably. The histopathological conclusions were: Intestinal Duplication clerk of the transverse colon. At present he is completely cured. A revision of the literature is carried out and the approaches of more interest are exposed.
Intestinal malrotation with suspected cow’s milk allergy: a case report
Takuma Matsuki, Akimune Kaga, Susumu Kanda, Yutaka Suzuki, Muneyuki Tanabu, Naoya Sawa
BMC Research Notes , 2012, DOI: 10.1186/1756-0500-5-481
Abstract: The patient was a Japanese male born at 39 weeks of gestation. He was breast-fed and received commercial cow’s milk supplementation starting the day of birth and was admitted to our hospital at 6 days of age due to bilious vomiting. Plain abdominal radiography showed a paucity of gas in the distal bowel. Because we demonstrated malpositioning of the intestine by barium enema, we repositioned the bowel in a normal position by laparotomy. The patient was re-started on only breast milk 2 days post surgery because we suspected the presence of a cow’s milk allergy, and the results of an allergen-specific lymphocyte stimulation test showed a marked increase in lymphocyte response to kappa-casein. At 5 months of age, the patient was subjected to a cow’s milk challenge test. After the patient began feeding on cow’s milk, he had no symptoms and his laboratory investigations showed no abnormality. In addition, because the patient showed good weight gain and no symptoms with increased cow’s milk intake after discharge, we concluded that the present case was not the result of a cow’s milk allergy. At 1 year, the patient showed favorable growth and development, and serum allergy investigations revealed no reaction to cow’s milk.When physicians encounter infants with surgical gastrointestinal disease, including intestinal malrotation, they should consider cow’s milk allergy as a differential diagnosis or complication and should utilize food challenge tests for a definitive diagnosis.Intestinal malrotation (IM) is the incomplete rotation of the intestine during fetal development [1]. Failure to rotate leads to abnormalities in intestinal positioning and attachment that may leave obstructing bands across the duodenum and a narrow pedicle for the midgut loop, thus rendering it susceptible to volvulus. Infants affected with IM often present during the first week of life with bilious emesis. The upper gastrointestinal series is the imaging test of choice and the gold standard in the e
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