Management of anomalous rotation in adults

Rotational anomalies of the gut are infrequently encountered in the adult population. Management of this population is debatable because of a few anecdotal reports and small patient series. We present the successful surgical correction of a patient with symptomatic nonrotation and review our experience with six asymptomatic patients with anomalous rotation discovered incidentally at laparotomy for another disease process. The incidence of anomalous rotation is reported as high as 0.5% in autopsy series. Therefore, a large majority of subjects are clinically silent throughout life. Although a surgical emergency in the pediatric population, serendipituous discovery in the asymptomatic adult does not require surgical intervention. It is important, however, that the patient have a thorough understanding of his abnormality so that should symptoms arise, urgent surgical intervention may be warranted. We recommend appendectomy in those patients undergoing laparotomy for other conditions. In patients with chronic abdominal symptoms, surgical intervention is warranted.