2008 Volume 28 Issue 7 Pages 985-988
A 72-year-old male visited our hospital complaining of intermittent abdominal pain from the early morning, emesis, and diarrhea. The patient's medical history included a partial visceral inversion and a cholecystectomy. He was diagnosed as having infectious enteritis and subileus and was placed under conservative medical management. However, the abdominal pain recurred on the 4th day of the illness, and the patient was diagnosed as having a strangulation ileus and underwent emergency surgery. The ascending colon was not fixed to the retroperitoneum and the patient was diagnosed as having bowel malrotation and incomplete fixation. In addition, torsion from the unfixed ileocecal region to the ascending colon also developed into ischemic necrosis. A 10-mm perforation was found in the center and a resection was performed from the ileocecal region to the ascending colon, followed by an ileostomy. After undergoing surgery, the patient entered septic shock, requiring artificial respiratory management, endotoxin adsorption therapy, and continuous hemodiafiltration. The general conditions thereafter tended to recover, but on the 15th day after surgery, the patient developed acute myocardial infarction and died. We therefore believe it necessary to take bowel malrotation into consideration for cases of ileus in patients with visceral inversion.
