Intestinal malrotation and volvulus in adult life.
BACKGROUND
Midgut volvulus due to intestinal malrotation is a rare cause of intestinal obstruction when occurring in adult life. This paper documents the difficulties in reaching an early diagnosis.


METHODS
We describe the case of an 85-year-old man with non-specific abdominal complaints for 20 years, who presented with sudden onset central abdominal pain. An acute median laparotomy under general anaesthesia was performed during which a 360° clockwise rotation of the small bowel around the mesenteric pedicle of the superior mesenteric artery and vein was found.


CONCLUSIONS
Malrotation is considered any deviation of the normal rotation of the midgut in embryological development, causing intermittent episodes of gastrointestinal obstruction or acute events of midgut volvulus. Although mainly a paediatric diagnosis, some cases do present in adult life. Radiologic investigations include: upper gastrointestinal contrast studies, Doppler sonography and a contrast enhanced CT of the abdomen. If a true malrotation is diagnosed or found by coincidence, a Ladd's procedure is advised, even if the patient is asymptomatic. There is no proven surgical strategy for preventing the recurrence of small bowel volvulus in case of malfixation of the midgut.


CONCLUSIONS
Non-specific recurrent abdominal complaints in adults of any age should raise suspicion of the possibility of a midgut malrotation or malfixation with or without intermittent volvulus. This case highlights the importance of diagnosis in an early stage.
Department of Surgery, Waterland Hospital, Waterlandlaan 250, 1441 RN Purmerend, The Netherlands. Electronic address: b.w.haak@amc.uva.nl.
Bastiaan W
BW
Haak
Department of Radiology, Waterland Hospital, Waterlandlaan 250, 1441 RN Purmerend, The Netherlands.
Sander T
ST
Bodewitz
Department of Pediatric Surgery, Emma Children's Hospital-AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Caroline F
CF
Kuijper
Department of Surgery, Waterland Hospital, Waterlandlaan 250, 1441 RN Purmerend, The Netherlands.
Louise M
LM
de Widt-Levert
Malrotation; Volvulus