Limits...
Intestinal Malrotation With a Fixed Partial Volvulus in an Adult.

Park YJ - Ann Coloproctol (2015)

Bottom Line: An upper gastrointestinal series and a computed tomography scan revealed an intestinal malrotation with a volvulus.Surgical intervention needs to be performed for an old intestinal malrotation with any symptoms because the structural or morphological change proceeds as time passes, which is caused by fibrosis due to tension being repetitively applied to Ladd's band, leading to its contraction.Furthermore, a severe contraction may even lead to a fixed partial volvulus.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery, Dankook University College of Medicine, Cheonan, Korea.

ABSTRACT
A 44-year-old man had been suffering from nausea, vomiting and watery diarrhea for 5 days and was then admitted to Dankook University Hospital. He had suffered from several episodes of mild symptoms, including abdominal distension, loss of appetite, easy satiety, nausea, vomiting, and diarrhea throughout his lifetime, but most episodes had been ignored by him or physicians. An upper gastrointestinal series and a computed tomography scan revealed an intestinal malrotation with a volvulus. In order to untwist the small bowel in a counterclockwise direction to about 180 degrees, we had to perform not only a dissection of Ladd's band, but also a dissection of other adhesions between the mesocolon and the mesenteric vessel trunk. Surgical intervention needs to be performed for an old intestinal malrotation with any symptoms because the structural or morphological change proceeds as time passes, which is caused by fibrosis due to tension being repetitively applied to Ladd's band, leading to its contraction. Furthermore, a severe contraction may even lead to a fixed partial volvulus.

No MeSH data available.


Related in: MedlinePlus

A computed tomography scan shows not only a huge dilated duodenum but also a 'whirling' of the mesenteric vessel trunk (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4496453&req=5

Figure 2: A computed tomography scan shows not only a huge dilated duodenum but also a 'whirling' of the mesenteric vessel trunk (arrow).

Mentions: A 44-year-old man with a height of 157 cm and a weight of 44 g, who had been suffering from nausea, vomiting and watery diarrhea for 5 days, was admitted to the hospital. He was runty at first glance. He had suffered from several episodes of mild symptoms, including abdominal distension, loss of appetite, easy satiety, nausea, and diarrhea throughout his life. He occasionally had severe symptoms of vomiting, abdominal cramping pain, and weight loss. He had received several gastroscopic exams for his symptoms, but was told it was only gastritis. After gastric decompression and treatment for moderate dehydration and electro-imbalance, we performed a gastrointestinal (UGI) series and a computed tomography (CT) scan one day after admission. The UGI series revealed a marked dilatation of the whole duodenum and an abrupt obstruction (Fig. 1). The CT scan also showed a huge dilated duodenum and a 'whirling' of the mesenteric vessel trunk (Fig. 2). The author attempted laparoscopic surgery, but failed because huge duodenum made identification of the parts of the anatomy difficult. In addition, a thick and closely adhered band between the duodenum and the ascending colon, where inevitable iatrogenic bowel injury had been predicted, interrupted the dissection (Figs. 3, 4). The mesenteric vessel trunk was severely adhered to the mesocolon and caused a narrowing of the mesenteric root. All of the whole mesenteric veins were tortuously engorged by a chronic kink of the proximal veins (Fig. 4). Without relief of the mesocolonic adhesion, a counterclockwise detorsion was not possible. In order to untwist the small bowel by about 180 degrees in a counterclockwise direction, we had to perform not only a simple dissection of Ladd's band but also a dissection of mesocolonic adhesions. At one day after starting oral intake (4 days after surgery), chylous ascites was drained. After conservative treatment, the patient was discharged 19 days after the surgery. At the three month follow-up, he did not feel any relative symptoms.


Intestinal Malrotation With a Fixed Partial Volvulus in an Adult.

Park YJ - Ann Coloproctol (2015)

A computed tomography scan shows not only a huge dilated duodenum but also a 'whirling' of the mesenteric vessel trunk (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496453&req=5

Figure 2: A computed tomography scan shows not only a huge dilated duodenum but also a 'whirling' of the mesenteric vessel trunk (arrow).
Mentions: A 44-year-old man with a height of 157 cm and a weight of 44 g, who had been suffering from nausea, vomiting and watery diarrhea for 5 days, was admitted to the hospital. He was runty at first glance. He had suffered from several episodes of mild symptoms, including abdominal distension, loss of appetite, easy satiety, nausea, and diarrhea throughout his life. He occasionally had severe symptoms of vomiting, abdominal cramping pain, and weight loss. He had received several gastroscopic exams for his symptoms, but was told it was only gastritis. After gastric decompression and treatment for moderate dehydration and electro-imbalance, we performed a gastrointestinal (UGI) series and a computed tomography (CT) scan one day after admission. The UGI series revealed a marked dilatation of the whole duodenum and an abrupt obstruction (Fig. 1). The CT scan also showed a huge dilated duodenum and a 'whirling' of the mesenteric vessel trunk (Fig. 2). The author attempted laparoscopic surgery, but failed because huge duodenum made identification of the parts of the anatomy difficult. In addition, a thick and closely adhered band between the duodenum and the ascending colon, where inevitable iatrogenic bowel injury had been predicted, interrupted the dissection (Figs. 3, 4). The mesenteric vessel trunk was severely adhered to the mesocolon and caused a narrowing of the mesenteric root. All of the whole mesenteric veins were tortuously engorged by a chronic kink of the proximal veins (Fig. 4). Without relief of the mesocolonic adhesion, a counterclockwise detorsion was not possible. In order to untwist the small bowel by about 180 degrees in a counterclockwise direction, we had to perform not only a simple dissection of Ladd's band but also a dissection of mesocolonic adhesions. At one day after starting oral intake (4 days after surgery), chylous ascites was drained. After conservative treatment, the patient was discharged 19 days after the surgery. At the three month follow-up, he did not feel any relative symptoms.

Bottom Line: An upper gastrointestinal series and a computed tomography scan revealed an intestinal malrotation with a volvulus.Surgical intervention needs to be performed for an old intestinal malrotation with any symptoms because the structural or morphological change proceeds as time passes, which is caused by fibrosis due to tension being repetitively applied to Ladd's band, leading to its contraction.Furthermore, a severe contraction may even lead to a fixed partial volvulus.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery, Dankook University College of Medicine, Cheonan, Korea.

ABSTRACT
A 44-year-old man had been suffering from nausea, vomiting and watery diarrhea for 5 days and was then admitted to Dankook University Hospital. He had suffered from several episodes of mild symptoms, including abdominal distension, loss of appetite, easy satiety, nausea, vomiting, and diarrhea throughout his lifetime, but most episodes had been ignored by him or physicians. An upper gastrointestinal series and a computed tomography scan revealed an intestinal malrotation with a volvulus. In order to untwist the small bowel in a counterclockwise direction to about 180 degrees, we had to perform not only a dissection of Ladd's band, but also a dissection of other adhesions between the mesocolon and the mesenteric vessel trunk. Surgical intervention needs to be performed for an old intestinal malrotation with any symptoms because the structural or morphological change proceeds as time passes, which is caused by fibrosis due to tension being repetitively applied to Ladd's band, leading to its contraction. Furthermore, a severe contraction may even lead to a fixed partial volvulus.

No MeSH data available.


Related in: MedlinePlus