JOURNAL ARTICLE

A rare presentation of midgut malrotation as an acute intestinal obstruction in an adult: Two case reports and literature review

Shailendra Singh, Anupam Das, A S Chawla, S V Arya, Jasneet Chaggar
International Journal of Surgery Case Reports 2013, 4 (1): 72-5
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INTRODUCTION: Midgut malrotation is a congenital anomaly presenting mainly in the childhood. Its presentation as an acute intestinal obstruction is extremely rare in adults usually recognized intra-operatively, therefore a high index of suspicion is always required when dealing with any case of acute intestinal obstruction.

PRESENTATION OF CASE: We report two cases of young adults who presented with symptoms of acute intestinal obstruction and were diagnosed intra-operatively as cecal volvulus and paraduodenal hernia, respectively, caused by midgut malrotation. Post-operative CT scan confirmed these findings.

DISCUSSION: Malrotation of the intestinal tract is a product of an aberrant embryology. The presentation of intestinal malrotation in adults is rare (0.2-0.5%). Contrast enhanced CT can show the abnormal anatomic location of a right sided small bowel, a left-sided colon and an abnormal relationship of the superior mesenteric vein (SMV) situated to the left of the superior mesenteric artery (SMA) instead of to the right.

CONCLUSION: Anomalies like midgut malrotation can present as an operative surprise and awareness regarding these anomalies can help surgeons deal with these conditions.

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