Asymptomatic Intestinal Malrotation Progressing to Midgut Volvulus in a Decompensated Alcoholic Cirrhotic Adult: A Rare Scenario Requiring Special Considerations
Intestinal malrotation usually presents in the pediatric population with midgut volvulus requiring emergency Ladd’s procedure. Rarely, it remains asymptomatic and is discovered incidentally only during adulthood when it seldom causes intestinal complications. The scenario of a cirrhotic adult being...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Case Reports in Surgery |
| Online Access: | http://dx.doi.org/10.1155/2020/4196012 |
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| author | Vatche Melkonian Pablo Quadri Chintalapati R. Varma Mustafa Nazzal Henry B. Randall Minh-Tri J. P. Nguyen |
| author_facet | Vatche Melkonian Pablo Quadri Chintalapati R. Varma Mustafa Nazzal Henry B. Randall Minh-Tri J. P. Nguyen |
| author_sort | Vatche Melkonian |
| collection | DOAJ |
| description | Intestinal malrotation usually presents in the pediatric population with midgut volvulus requiring emergency Ladd’s procedure. Rarely, it remains asymptomatic and is discovered incidentally only during adulthood when it seldom causes intestinal complications. The scenario of a cirrhotic adult being diagnosed with asymptomatic intestinal malrotation with subsequent intestinal complications is thus extremely rare and to our knowledge has not been previously reported. We describe a 56-year-old man with decompensated alcoholic cirrhosis (Child-Pugh class C, MELD score 22) who was initially observed after an incidental diagnosis of intestinal malrotation on computed tomography. Observation continued as his liver disease improved with alcohol cessation (Child-Pugh class A, MELD score 8). He later presented with a closed loop bowel obstruction secondary to midgut volvulus at the time of alcohol relapse and liver redecompensation (Child-Pugh class C, MELD score 22-29). He underwent emergency Ladd’s procedure during which his midjejunum was volvulized into an internal hernia space created by a thick Ladd’s band containing large varices. The postoperative course was complicated by ileus and loculated bacterial peritonitis. Based on our experience, we discuss special considerations with regard to the surgical technique and timing of Ladd’s procedure when encountering intestinal malrotation in a cirrhotic adult with portal hypertension. |
| format | Article |
| id | doaj-art-4c775dea4635438fa773346e263e9a63 |
| institution | Kabale University |
| issn | 2090-6900 2090-6919 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Surgery |
| spelling | doaj-art-4c775dea4635438fa773346e263e9a632025-02-03T01:04:47ZengWileyCase Reports in Surgery2090-69002090-69192020-01-01202010.1155/2020/41960124196012Asymptomatic Intestinal Malrotation Progressing to Midgut Volvulus in a Decompensated Alcoholic Cirrhotic Adult: A Rare Scenario Requiring Special ConsiderationsVatche Melkonian0Pablo Quadri1Chintalapati R. Varma2Mustafa Nazzal3Henry B. Randall4Minh-Tri J. P. Nguyen5Division of Abdominal Transplant, Department of Surgery, Saint Louis University, Saint Louis, MO, USADivision of Abdominal Transplant, Department of Surgery, Saint Louis University, Saint Louis, MO, USADivision of Abdominal Transplant, Department of Surgery, Saint Louis University, Saint Louis, MO, USADivision of Abdominal Transplant, Department of Surgery, Saint Louis University, Saint Louis, MO, USADivision of Abdominal Transplant, Department of Surgery, Saint Louis University, Saint Louis, MO, USADivision of Abdominal Transplant, Department of Surgery, Saint Louis University, Saint Louis, MO, USAIntestinal malrotation usually presents in the pediatric population with midgut volvulus requiring emergency Ladd’s procedure. Rarely, it remains asymptomatic and is discovered incidentally only during adulthood when it seldom causes intestinal complications. The scenario of a cirrhotic adult being diagnosed with asymptomatic intestinal malrotation with subsequent intestinal complications is thus extremely rare and to our knowledge has not been previously reported. We describe a 56-year-old man with decompensated alcoholic cirrhosis (Child-Pugh class C, MELD score 22) who was initially observed after an incidental diagnosis of intestinal malrotation on computed tomography. Observation continued as his liver disease improved with alcohol cessation (Child-Pugh class A, MELD score 8). He later presented with a closed loop bowel obstruction secondary to midgut volvulus at the time of alcohol relapse and liver redecompensation (Child-Pugh class C, MELD score 22-29). He underwent emergency Ladd’s procedure during which his midjejunum was volvulized into an internal hernia space created by a thick Ladd’s band containing large varices. The postoperative course was complicated by ileus and loculated bacterial peritonitis. Based on our experience, we discuss special considerations with regard to the surgical technique and timing of Ladd’s procedure when encountering intestinal malrotation in a cirrhotic adult with portal hypertension.http://dx.doi.org/10.1155/2020/4196012 |
| spellingShingle | Vatche Melkonian Pablo Quadri Chintalapati R. Varma Mustafa Nazzal Henry B. Randall Minh-Tri J. P. Nguyen Asymptomatic Intestinal Malrotation Progressing to Midgut Volvulus in a Decompensated Alcoholic Cirrhotic Adult: A Rare Scenario Requiring Special Considerations Case Reports in Surgery |
| title | Asymptomatic Intestinal Malrotation Progressing to Midgut Volvulus in a Decompensated Alcoholic Cirrhotic Adult: A Rare Scenario Requiring Special Considerations |
| title_full | Asymptomatic Intestinal Malrotation Progressing to Midgut Volvulus in a Decompensated Alcoholic Cirrhotic Adult: A Rare Scenario Requiring Special Considerations |
| title_fullStr | Asymptomatic Intestinal Malrotation Progressing to Midgut Volvulus in a Decompensated Alcoholic Cirrhotic Adult: A Rare Scenario Requiring Special Considerations |
| title_full_unstemmed | Asymptomatic Intestinal Malrotation Progressing to Midgut Volvulus in a Decompensated Alcoholic Cirrhotic Adult: A Rare Scenario Requiring Special Considerations |
| title_short | Asymptomatic Intestinal Malrotation Progressing to Midgut Volvulus in a Decompensated Alcoholic Cirrhotic Adult: A Rare Scenario Requiring Special Considerations |
| title_sort | asymptomatic intestinal malrotation progressing to midgut volvulus in a decompensated alcoholic cirrhotic adult a rare scenario requiring special considerations |
| url | http://dx.doi.org/10.1155/2020/4196012 |
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