• Adult
• Case report
• Congenital malrotation
• Exploratory laparotomy
• Midgut volvulus
• Misdiagnose

• Humans
• Intestinal Volvulus/etiology
• Intestinal Volvulus/surgery
• Digestive System Surgical Procedures/methods
• Retrospective Studies

• Adult
• Laparoscopic
• Malrotation

• Child
• Humans
• Adult
• Adolescent
• Retrospective Studies
• Vomiting/etiology
• Abdominal Pain/etiology
• Abdomen, Acute
• Length of Stay
• Intestinal Volvulus/diagnostic imaging
• Intestinal Volvulus/surgery

• Case report
• Coecopexy
• Incomplete common mesentery
• Surgery
• Volvulus

• autologous gut reconstruction
• colonic dysmotility
• congenital anomalies
• embryonic rotation
• gastrointestinal symptoms
• gastroschisis
• gut malrotation
• gut malrotation correction surgery
• kareem's procedure
• gut transplantation
• intestinal atresia
• intestinal malrotation
• ladd's procedure
• mesenteric fixation
• mid-gut volvulus
• oro-cecal transit time
• radiology

• Adolescent
• Adult
• Child
• Child, Preschool
• Cohort Studies
• Digestive System Surgical Procedures
• Female
• Humans
• Infant
• Infant, Newborn
• Intestinal Volvulus/etiology
• Intestinal Volvulus/mortality
• Intestinal Volvulus/surgery
• Male
• Plastic Surgery Procedures
• Survival Rate
• Treatment Outcome
• Young Adult

We present a rare case of recurrent primary midgut volvulus in an elderly female with an interesting intraoperative finding of an abnormally elongated small bowel mesentery. This patient presented with symptoms of obstruction, including nausea, vomiting and obstipation, similar to previous episodes of volvulus for which she underwent exploratory laparotomies and reduction of the volvulus. We describe a novel use for enteropexy in which we effectively shortened the small bowel mesentery in an effort to eliminate the source of recurrent volvulus. The patient’s post-operative course was complicated by prolonged ileus requiring total parenteral nutrition. However, she had not developed signs or symptoms of bowel ischemia or recurrent volvulus at the time of this writing. Our findings suggest that enteropexy is an effective technique for preventing recurrent midgut volvulus primarily caused by abnormally elongated mesentery.

To classify adult intestinal malrotation by CT.

This retrospective study enrolled adults diagnosed with intestinal malrotation who underwent abdominal CT at our institution between June 1, 2013, and August 30, 2020. All patients’ clinical information was recorded. Patients were divided into groups undergoing surgical and conservative management. The duodenum (nonrotation, partial rotation, and malrotation), jejunum, cecum, and the superior mesenteric artery/superior mesenteric vein relationship were reviewed on the CT images of each patient, and classification criteria developed based on the first three items. For each patient, each item was assessed separately by three radiologists. Consensus was required from at least two of them.

A total of 332 eligible patients (218 men and 114 women; mean age 51.0 ± 15.3 years) were ultimately included and classified into ten types of malrotation. Duodenal partial rotation was present in most (73.2%, 243/332) with only 25% (83/332) demonstrating nonrotation. The jejunum was located in the right abdomen in 98.2% (326/332) of cases, and an ectopic cecum was found in only 12% (40/332, 29 cases with a left cecum, 7 pelvic, and 4 at midline). Asymptomatic patients comprised 56.6% (188/332) of cases, much higher than that in previous studies (17%, n = 82, p < .001), comprised mainly of patients with duodenal partial rotation (80.3%, 151/188). In 91 patients with detailed clinical data available (12 managed surgically and 79 conservatively), a significant difference in malrotation CT categorization was identified (p = .016).

CT enables greater detection of asymptomatic intestinal malrotation, enabling classification into multiple potentially clinically relevant subtypes.

The online version contains supplementary material available at 10.1186/s13244-021-00999-3.

• Adults
• Computed tomography
• Diagnosis
• Intestinal malrotation

•

Chylous ascites due to intestinal malrotation is a rare occurrence, especially in adolescent and adult patients.

Intestinal malrotation is a rare etiology of chylous ascites in adolescents. Chylous ascites is caused by lymphatic system disarrangement, which can result in an anomalous build-up of a lymphatic fluid rich in lipid, namely chyle in the peritoneal cavity.

We present a case of a 16-year-old Saudi Arabian male who came to the emergency department with right upper quadrant pain associated with difficulty in passing stool for one day and a history of congenital diaphragmatic hernia (CDH) repair at the age of 4 months. Free fluid in the abdomen was noticed in the bedside ultrasound. Abdominopelvic computed tomography revealed dilated small bowel loops and a whirl sign of the mesentery, which indicated intestinal torsion. The patient was treated using Ladd’s procedure, and a large volume of chylous fluid was removed from the abdomen. Postoperatively, the abdominal drain revealed no chyle, and the patient was followed-up as an outpatient at which point, he reported no abdominal pain.

Intestinal malrotation is more commonly reported in children and associated with congenital chylous ascites. Chylous ascites by itself is a rare occurrence, and very few cases attribute it to intestinal malrotation in adults. Surgical management with Ladd’s procedure is a well-documented surgery in pediatric patients, and yet it was successfully performed in our adolescent patient.

Surgical management of chylous ascites secondary to intestinal malrotation in an adolescent, which is considered novel in this age group, including peritoneal lavage of chyle, resulted in favorable outcomes.

• Adolescent
• Case report
• Chylous ascites
• Intestinal malrotation

• infant
• intestinal volvulus
• laparoscopy
• malrotation
• newborn

Vomiting with failure to thrive in older children is a diagnostic challenge due to the diversity in the diagnosis. We report a case of a five-years-old girl with failure to thrive, history of recurrent vomiting and intermittent colicky pain abdomen since 45 days of life. Intestinal malrotation with Ladd's band was diagnosed based on clinical acumen, high-resolution computed tomography, barium follow through and intraoperative findings. Exploratory laparotomy with Ladd's procedure was performed under general anesthesia which showed malrotation at the duodenojejunal junction with a short route of mesentery with floating caecum with Ladd's band. Failure to thrive with malrotation of the gut in the older age group is rare in itself. As there are very few cases reported in this age group, so we undertook to report this case to increase the awareness of knowledge concerning the diagnosis and timely management to prevent the comorbidity of this condition.

• exploratory laparotomy; failure to thrive; intestinal malrotation.