ANOMALIES OF THE MIDGUT ROTATION IN THE ADULT

Abstract

Rotational anomalies of the midgut are rare in adults. Operative intervention is required generally when they are symptomatic. In this article, six adult patients with symptomatic rotational anomalies of the midgut (two paraduodenal hernias, two malrotation, one nonrotation and one reversed rotation) have been reported. Of the six patients, intestinal obstruction was observed in three cases, duodenal ileus in two and midgut volvulus in one. All six cases had the diagnosis of rotational anomaly of midgut by laparotomy.

In some anomalies (like reversed rotation, nonrotation, malrotation) anatomical repositioning of the midgut may be impossible and the surgeon can only manage the accompanying disorders (like intestinal obstruction, duodenal ileus, mobile mesentery and Ladd's Bands). In the two paraduodenal hernias with intestinal obstruction due to loops trapped in the hernia sac, the contents were emptied and the sac closed. Mobile mesentery was fixed in the two malrotation cases and one duodenal obstruction due to Ladd's bands was treated by Ladd's operation. In the other patient with intestinal obstruction was treated by reduction of midgut volvulus. The nonrotation patient with caecal volvulus was treated by detortion of the volvulus. The patient with reversed rotation had a Ladd's operation for duodenal ileus and right hemicolectomy for retroarterial colon entrappement.