Midgut Volvulus with Intestinal Malrotation in an Adult: A Case Report
Published: 2022-11-09
Page: 391-396
Issue: 2022 - Volume 5 [Issue 2]
Sachin Arora *
Department of Surgical Gastroenterology, S. N. Medical College, Agra, India.
Rohit Dhawan
Department of Surgical Gastroenterology, S. N. Medical College, Agra, India.
Gopal Krishna Dwivedi
Department of Surgery, S. N. Medical College, Agra, India.
Shivam Sharma
Department of Surgery, S. N. Medical College, Agra, India.
Aradhana Singh
Department of Surgery, S. N. Medical College, Agra, India.
*Author to whom correspondence should be addressed.
Abstract
Background: Intestinal malrotation is a rare congenital disorder characterized by non-rotation or partial rotation of the small bowel around the superior mesenteric arteries during the embryonic stage, resulting in mid-gut volvulus. Approximately 64–90% of patients' symptoms manifest as acute intestinal obstruction due to midgut volvulus before the age of one year, but the presentation in adulthood is infrequent (0.2–0.5%).
Case Report: A 26-year-old lady came to us complaining of intermittent colicky discomfort, vomiting, and constipation for the previous three months. The patient's vitals were stable clinically, with 112/64 mmHg blood pressure, 72 bpm heart rate, 16 rpm respiration rate, 98.4 °F (36.9 °C) temperature, and 100% O2 saturation on room air. The abdomen was mildly distended but had no tenderness or guarding. Abdominal Contrast CT(CECT) revealed a reversal of the relationship between the superior mesenteric vessels, a whirling appearance of the mesentery, and a twisting of the mesentery vessels (whirlpool sign), indicating mid-gut volvulus and intestinal malrotation. Emergency surgical intervention was scheduled for the patient.
Conclusion: Although malrotation is frequent in childhood, symptomatic midgut malrotation can occur in adults with non-specific symptoms. Imaging and a high suspicion level are critical in diagnosing.
Keywords: Adult intestinal malrotation, malrotation, midgut volvulus, whirlpool sign
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