Recurrent acute pancreatitis caused by malrotation of the intestine and effective treatment with laparoscopic Ladd's procedure

We herein report a rare case of recurrent pancreatitis caused by malrotation of the intestine. Since the age of 10 years, a female patient showed recurrent epigastralgia and was diagnosed at age 16 years as suffering from acute pancreatitis. Upper gastrointestinal series showed that the duodenal bulb was elongated and rotated caudally. Endoscopic retrograde cholangiopancreatography showed that the descending portion of the duodenum was rotated and occluded the papilla of Vater. Under laparoscopy, the duodenal bulb was tracted caudally by the Ladd's ligament. By incision of this ligament, the entire duodenum was mobilized, with subsequent reduction of the rotation and compression of the pancreatic head. The girl's postoperative course was uneventful, and she has been asymptomatic for the last 3 years. In conclusion, malrotation of the intestine may be a rare cause of recurrent pancreatitis, and laparoscopic Ladd's procedure may be a less invasive and useful treatment.