Diagnostic Delay in Intestinal Malrotation Presenting During Adolescence
A Case Report and Review of Literature
DOI:
https://doi.org/10.4314/ajtmbr.v8i1.10Keywords:
adolescence, Intestinal malrotation, recurrent abdominal pain, Ladd’s procedureAbstract
Introduction: Intestinal malrotation refers to any variation in the rotation and fixation of the gastrointestinal tract during development. While most cases present in infancy with acute obstructive symptoms, a significant number remain undiagnosed until later in childhood or adulthood, often exhibiting vague or nonspecific symptoms that complicate timely diagnosis and management.
Case Report: A 10-year-old boy presented with recurrent abdominal pain of 5 years’ duration, recent onset of bilious vomiting, and constipation. Barium meal and follow-through imaging revealed a markedly distended stomach and proximal duodenum that ended blindly. Exploratory laparotomy confirmed intestinal malrotation with midgut torsion, and Ladd’s procedure was performed. The patient recovered uneventfully and has remained asymptomatic on follow-up.
Conclusion: This case emphasizes the importance of considering intestinal malrotation as a differential diagnosis in older children with recurrent abdominal pain. Early recognition may prevent catastrophic complications such as bowel ischemia, chronic midgut volvulus, malnutrition, and short bowel syndrome.
References
Rogalidou M, Xydis V, Palianopoulos T, Makariou S, Papadopoulos I, Argyropoulou M, et al. Malrotation in childhood: pitfalls in its recognition and diagnosis. Malays J Paediatr Child Health. 2024;30(3):50–55.
Kotze PG, Martins JF, Rocha JG, Freitas CD, Steckert JS, Fugita E. Ladd procedure for adult intestinal malrotation: case report. Arq Bras Cir Dig. 2011;24(1):89–91.
Nehra D, Goldstein AM. Intestinal malrotation: varied clinical presentation from infancy through adulthood. Surgery. 2011;149(3):386–393.
Arthur F, Carachi R. Malrotation in infancy and childhood. Scott Med J. 2016;61(2):69–73.
Nagdeve NG, Qureshi AM, Bhingare PD, Shinde SK. Malrotation beyond infancy. J Pediatr Surg. 2012;47(11):2026–2032.
Nguyen RK, Crouse RM, Talbot EA, Allard-Picou AK. Intestinal malrotation in the adult. Am Surg. 2022;88(6):1367–1368.
Fukuya T, Brown BP, Lu CC. Midgut volvulus as a complication of intestinal malrotation in adults. Dig Dis Sci. 1993;38(3):438–444.
Dietz DW, Walsh RM, Grundfest-Broniatowski S, Lavery IC, Fazio VW, Vogt DP. Intestinal malrotation: a rare but important cause of bowel obstruction in adults. Dis Colon Rectum. 2002;45(10):1381–1386.
Tagar E, Kpolugbo J, Udefiagbon EO. Diagnostic dilemma in teenage presentation of intestinal malrotation: report of two cases and review of the literature. Clin Case Rep Open Access. 2023;6(2):257.
Gamblin TC, Stephens RE Jr, Johnson RK, Rothwell M. Adult malrotation: a case report and review of the literature. Curr Surg. 2003;60(5):517–520.
McMahon E, Penfold M, Cain M. 18-year-old with abdominal pain due to congenital bowel malrotation: a case report. Clin Pract Cases Emerg Med. 2022;6(1):65.
Pickhardt PJ, Bhalla S. Intestinal malrotation in adolescents and adults: spectrum of clinical and imaging features. AJR Am J Roentgenol. 2002;179(6):1429–1435.
Nasir AA, Abdur-Rahman LO, Adeniran JO. Outcomes of surgical treatment of malrotation in children. Afr J Paediatr Surg. 2011;8(1):8–11.
Catania VD, Lauriti G, Pierro A, Zani A. Open versus laparoscopic approach for intestinal malrotation in infants and children: a systematic review and meta-analysis. Pediatr Surg Int. 2016;32(12):1157–1164.
Arnaud AP, Suply E, Eaton S, Blackburn SC, Giuliani S, Curry JI, et al. Laparoscopic Ladd's procedure for malrotation in infants and children is still a controversial approach. J Pediatr Surg. 2019;54(9):1843–1847.
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