INTESTINAL MALROTATION IN PATIENTS UNDERGOING BARIATRIC SURGERY.
Intestinal malrotation is a rare congenital anomaly. In adults is very difficult to recognize due to the lack of symptoms. Diagnosis is usually incidental during surgical procedures or at autopsy.



To review the occurrence and recognition of uneventful intestinal malrotation discovered during regular cases of bariatric surgeries.



Were retrospectively reviewed the medical registry of 20,000 cases undergoing bariatric surgery, from January 2002 to January 2016, looking for the occurrence of intestinal malrotation and consequences in the intraoperative technique and immediate evolution of the patients.



Five cases (0,025%) of intestinal malrotation were found. All of them were males, aging 45, 49, 37,52 and 39 years; BMI 35, 42, 49, 47 and 52 kg/m2, all of them with a past medical history of morbid obesity. The patient with BMI 35 kg/m2 suffered from type 2 diabetes also. All procedures were completed by laparoscopic approach, with no conversions. In one patient was not possible to move the jejunum to the upper abdomen in order to establish the gastrojejunostomy and a sleeve gastrectomy was performed. In another patient was not possible to fully recognize the anatomy due to bowel adhesions and a single anastomosis gastric bypass was preferred. No leaks or bleeding were identified. There were no perioperative complications. All patients were discharged 72 h after the procedure and no immediate 30-day complications were reported.



Patients with malrotation can successfully undergo laparoscopic bariatric surgery. May be necessary changes in the surgical original strategy regarding the malrotation. Surgeons must check full abdominal anatomical condition prior to start the division of the stomach.
Department of General Surgery, Hospital Clínica Alcívar, Guayaquil, Ecuador;
Eduardo Arevalo
EA
Vidal
Department of General Surgery, Hospital Clínica Alcívar, Guayaquil, Ecuador;
Francisco Abarca
FA
Rendon
Department of General Surgery, Hospital Clínica Alcívar, Guayaquil, Ecuador;
Trino Andrade
TA
Zambrano
Department of General Surgery, Hospital Clínica Alcívar, Guayaquil, Ecuador;
Yudoco Andrade
YA
García
Department of General Surgery, Hospital Clínica Alcívar, Guayaquil, Ecuador;
Mario Ferrin
MF
Viteri
Federal University of Pernambuco, Recife, Brazil;
Josemberg Marins
JM
Campos
Gastro-Obeso-Center Advanced Surgical Institute, São Paulo, Brazil.
Manoela Galvão
MG
Ramos
Gastro-Obeso-Center Advanced Surgical Institute, São Paulo, Brazil.
Almino Cardoso
AC
Ramos
Obes Surg. 2006 Jun;16(6):777-9
16756742
AJR Am J Roentgenol. 2002 Dec;179(6):1429-35
12438031
Ann Intern Med. 2005 Apr 5;142(7):547-59
15809466
Pediatr Radiol. 2004 Nov;34(11):837-51
15378215
Pediatr Surg Int. 2007 Aug;23(8):723-30
17594104
Obes Surg. 2004 Oct;14(9):1157-64
15527627
J Pediatr Surg. 1981 Aug;16(4 Suppl 1):614-20
7277164
Obes Surg. 2005 May;15(5):703-6
15946464
J Am Coll Surg. 2004 Oct;199(4):628-35
15454150
Dis Colon Rectum. 2002 Oct;45(10 ):1381-6
12394439
Surgery. 1990 Oct;108(4):710-5; discussion 715-6
2218883
Surg Endosc. 2005 Oct;19(10):1416-9
16151680
J Am Coll Surg. 1997 Aug;185(2):172-6
9249085
AJR Am J Roentgenol. 1983 Oct;141(4):707-8
6604422
Am Surg. 2007 Jul;73(7):693-6
17674943
J Gastrointest Surg. 2007 Jul;11(7):898-902
17487537
Dis Colon Rectum. 1994 Feb;37(2):192-8
8306846
Surgery. 1976 Jun;79(6):716-20
1273757
Obes Surg. 2005 Feb;15(2):155-63
15802056