[Clinical aspects and therapy of intestinal non-rotation in adults]

The intestinal non-rotation is a rare fetal disorder of the gut torsion. Its manifestation is very rarely seen in the adult, either in form of a volvulus of the midgut or ileocecal with an acute onset, or as chronic recurrent abdominal pain. Each diagnostic or therapeutic delay increases the risk of strangulation and may end as an abdominal disaster. We describe three own cases and we try to elucidate the diagnostic and therapeutic problems. Our proceeding: In the acute symptomatic form the explorative laparotomy with a consequent staging of the abdominal situs is the safest way to get an exact diagnosis. Therapeutically the procedure described by LADD is the best torsion prophylaxis; the ascending colon is sawn to the descending colon. Due to a paratopia, the appendectomy is recommended. In the chronic forms the contrast enema and the gastrointestinal barium study are the main diagnostic procedures. In the operation described by Fitzgerald and the ascending colon and the mesentery of the small bowel are--after incision of the common mesentery--fixed at their anatomical site.