Related Experiment Videos
[Surgical significance of intestinal non-rotation in adults]
1Chirurgische Klinik, Katonsspital Luzern.
Insights
Intestinal non-rotation, rare in adults, can cause obstruction or pain. Emergency surgery is vital for acute cases, while chronic forms benefit from imaging and surgical correction, leading to symptom-free recovery.
Area of Science:
- Gastroenterology
- Surgical Anatomy
- Pediatric Surgery
Background:
- Intestinal non-rotation is a congenital anomaly.
- While common in neonates, it's rare in adults.
- It poses risks of obstruction and volvulus.
Observation:
- Six adult cases were personally observed.
- Thirty-eight English and German case reports since 1923 were analyzed.
- The study reviewed both acute and chronic presentations.
Findings:
- Acute symptomatic intestinal non-rotation requires emergency laparotomy for diagnosis and to prevent bowel compromise.
- Chronic forms may present with intermittent abdominal pain.
- Barium studies can reveal malrotation; laparotomy confirms non-rotation and allows surgical correction.
Implications:
- Laparotomy is crucial for diagnosing and managing acute intestinal non-rotation in adults.
- Surgical correction, such as Ladd's procedure, effectively resolves symptoms and minimizes volvulus risk.
- Early diagnosis and surgical intervention ensure symptom-free outcomes for patients with intestinal non-rotation.
Abstract:
Intestinal non-rotation has been recognized as a cause of obstruction in neonates and children. It is very rarely seen in the adult and assumes surgical significance owing to the potential risk of midgut or ileocecal volvulus. However, it can also cause significant intermittent abdominal pain in the adult. We describe six personally observed patients with this malformation and analyze 38 case reports published in the English and German literature since 1923. We establish that in the acute symptomatic form only emergency laparotomy can provide the correct diagnosis and decrease the risk of bowel disturbance. In the chronic forms, barium studies of the whole intestinal tract reveal varying degrees of midgut malrotation and the non-rotation is confirmed in each case. Also in these forms, exploratory laparotomy with a consequent staging of the abdominal situs is to be recommended. In the operation described by Ladd the ascending colon is sutured at the colon descendens and sigmoideum. After this procedure the mesenterial pedicle is fixed and the risk of midgut torsion remains minimal. All reported cases after surgery are symptom-free.