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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Dietz
David W
DW
Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Walsh
R Matthew
RM
Grundfest-Broniatowski
Sharon
S
Lavery
Ian C
IC
Fazio
Victor W
VW
Vogt
David P
DP
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology*; D007422:Intestines / Q000002:abnormalities* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012399:Rotation; D014057:Tomography, X-Ray Computed