RAGHAVA S PAVOOR, MD, FENG BO, PhD, JEFFREY W MILSOM, MD FACS. WEILL CORNELL MEDICAL COLLEGE/NEW YORK PRESBYTERIAN HOSPITAL
Midgut malrotation is an anomaly of fetal intestinal rotation that is usually diagnosed in childhood.
We present a case of a 66 year old female with a history of chronic constipation and laxative abuse who presented with sudden onset abdominal distention. CT scan of abdomen and pelvis revealed congenital malrotation of the intestines with significant twisting of the small intestines, especially in the distal ileum, which was in the left upper quadrant. Laparoscopic evaluation confirmed the diagnostic findings. The small bowel was explored starting at the duodenum and the congenital adhesions (Ladd’s bands) were lysed and the duodenum was straightened completely. The small bowel was run and significant twisting of the distal small bowel was noted. The malrotation was reduced. Appendectomy was performed. The duodenum and proximal jejunum were plicated to the right retroperitoneum so that bowel would not twist along the base of the mesentery.
Postoperatively, the patient recovered rapidly and was discharged on the first postoperative day. At five month follow up, the patient is doing well.
Midgut malrotation manifesting in elderly patients is relatively uncommon. Laparoscopic repair in such an age group is feasible and potentially beneficial in terms of early discharge.
Program Number: V031