A Case of Volvulus in an Adolescent Caused by Intestinal Malrotation

Abstract

A 13-year-old male patient was transported to our hospital complaining of abdominal pain that had first started during his early morning exercise, but had gotten worse after lunch. The abdomen was flat and soft, with localized tenderness in the upper navel. Abdominal contrast-enhanced computed tomography (CT) showed clockwise twisting of the bowel around the superior mesenteric artery. The patient was diagnosed as having intestinal torsion and underwent emergency laparoscopic surgery. Intraoperative exploration of the abdominal cavity revealed no fixation to the retroperitoneum from the cecum to the hepatic flexure, and twisting of the ascending colon. As reduction proved difficult under laparoscopic guidance, the procedure was completed after conversion to open surgery. Both the ascending colon and the small intestine were found to be twisted clockwise by 180 degrees. After the twisted intestine was released, no evidence of necrosis or perforation of the intestine or colon was apparent. The patient was finally diagnosed as having had volvulus caused by intestinal malrotation. The ascending colon and retroperitoneum were fixed. Volvulus caused by intestinal malrotation is rare in adolescence.