title: Congenital intestinal malrotation in adolescent and adult patients: a 12-year clinical and radiological survey.
abstract: Congenital intestinal malrotation is mainly detected in childhood and caused by incomplete rotation and fixation of the intestines providing the prerequisites for life-threatening volvulus of the midgut. The objective of this study was to evaluate a large cohort of adult patients with intestinal malrotation. Thirty-nine patients, 15-67 years, were diagnosed and admitted to a university setting with congenital intestinal malrotation 2002-2013. The patients were divided into three age groups for stratified evaluation. Medical charts were scrutinized, and clinical outcome of surgery was reviewed. Twelve patients presented as emergency cases, whereas 27 were admitted as elective cases. Diagnosis was established in 33 patients who underwent radiological investigation and in the remaining 6 during surgery. A Ladd's operation was performed in 31 symptomatic patients; a conservative strategy was chosen in eight cases. Volvulus was more common in the younger age group. Twenty-six surgically treated patients were available for telephone interview, 1-12 years after surgery. All patients, except one, regarded their general condition improved to a high degree (n = 18) or with some reservation (n = 7). Twelve patients suffered remaining abdominal pain of a chronic and diffuse character. Due to recurrence of malrotation six patients were reoperated. Symptomatic malrotation occurs in both children and the adult population. Improved awareness and an accurately performed CT scan can reveal the malformation and enable surgical treatment. A Ladd's procedure relieved most patients from their severe complaints even when a history of several years of suffering existed.
authors.affiliation: Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden ; Department of Surgery, Ersta Hospital, Stockholm, Sweden ; Department of Clinical Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden ; Department of Gastrointestinal Surgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Britt
authors.initials: B
authors.lastname: Husberg
authors.affiliation: Department of Women's and Children's Health, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden ; Unit of Paediatric Surgery, Astrid Lindgren Children Hospital, Stockholm, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Salehi
authors.affiliation: Department of Radiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Trevor
authors.initials: T
authors.lastname: Peters
authors.affiliation: Department of Surgical and Perioperative Sciences, Umeå University Hospital, 901 87 Umeå, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Gunnarsson
authors.affiliation: Department of Clinical Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden ; Department of Gastrointestinal Surgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Margareta
authors.initials: M
authors.lastname: Michanek
authors.affiliation: Department of Women's and Children's Health, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden ; Unit of Paediatric Surgery, Astrid Lindgren Children Hospital, Stockholm, Sweden.
authors.forename: Agneta
authors.initials: A
authors.lastname: Nordenskjöld
authors.affiliation: Department of Surgical and Perioperative Sciences, Umeå University Hospital, 901 87 Umeå, Sweden.
authors.forename: Karin
authors.identifier: 0000-0001-5838-9133
authors.initials: K
authors.lastname: Strigård
keywords: Adult; Intestinal volvulus; Ladd’s procedure; Malrotation