Intestinal Malrotation Incidentally Found During Gastric Bypass

Alejandro Grigaites, MD, Veronica Gorodner, MD, Gaston Clemente, MD, Rudolf Buxhoeveden, MD. Programa de Unidades Bariatricas

Introduction: Intestinal malrotation is a congenital anomaly that results from inadequate rotation of the midgut during fetal development between weeks 5 and 12 of gestation. The incidence is 1 every 6000 live births. We present a case of intestinal malrotation incidentally found during gastric bypass surgery.

Description of contents: This was a 35 yo male, with BMI 43, referred to our clinic for the treatment of obesity. He did not have any comorbidities, and his past surgical history was negative. Decision was made, to perform a Roux -en- Y gastric bypass. The operation was started in the usual fashion, creating the gastric pouch. Next, we proceeded to identify the ligament of Treitz, but we failed. After several maneuvers, we were able to identify the ligament of Treitz, towards the right and outside of the colon. The operation proceeded with a different orientation, according to the patient’s anatomy.

Comments and/or observations: Even though its low incidence, this anomaly should be considered, since it may lead to misinterpretation of the intestinal loops with the consequent misconstruction of the gastric bypass.

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