A Case of Intestinal Malrotation in a 90-year-old Woman That Was Treated Successfully by Surgery

Abstract

A 90-year-old woman presented to our hospital with a 2-day history of vomiting and intermittent abdominal pain. Abdominal contrast-enhanced computed tomography (CT) showed the whirlpool sign extending between the site of the descending duodenum and proximal jejunum and the closed loop of the small intestine. We made the diagnosis of intestinal malrotation with midgut volvulus and performed emergency surgery. The duodenal obstruction was relieved after the clockwise torsion around the superior mesenteric artery (midgut volvulus) was released and the Ladd’s bands removed. As the Treitz ligament or transverse colon was not present behind the duodenum and small intestine, the patient was diagnosed as suffering from a reversed rotation type of intestinal malrotation. We did not perform abdominal wall fixation of the small intestine or colon. Postoperatively, the patient developed pneumonia; however, she was discharged in an ambulatory condition after 71 days of hospitalization and exhibited no recurrence of her abdominal symptoms after the operation. To the best of our knowledge, this was the oldest patient who underwent intestinal malrotation surgery in Japan. CT is useful for the diagnosis of intestinal malrotation, and considering surgery as early as possible is important in older patients with such symptoms.