A Case of Adult Intestinal Malrotation that was Operated on after a Long Illness from Infancy

Abstract

The case was a 61-year-old woman. She had repeated abdominal pain and vomiting since infancy, and sometimes developed acute renal failure and was hospitalized. Although intestinal malrotation was identified in her 20s, she had not had surgery. However, in recent years, she had been repeatedly admitted to and discharged from the Department of Gastroenterology at our hospital with the diagnosis of intestinal obstruction, and she was referred to the Department of Gastrointestinal Surgery. Preoperative investigation showed intestinal malrotation, which was classified as incomplete rotation type. She underwent elective laparoscopic surgery. The cord-like tissue in front of the duodenal-jejunal junction was dissected, and the 180-degree clockwise twist around the superior mesenteric artery of the small intestine was released (Ladd surgery). She had transient intestinal obstruction symptoms in the early postoperative period, but about 1 year has passed since then without relapse of the symptoms. When the reports of adult intestinal malrotation in Japan were collected, in the case of incomplete rotation type, the rate of symptoms was significantly higher with intestinal malrotation than with the non-rotation type. The rate of Ladd surgery, such as dissection of the Ladd ligament and release of axial twist, was also significantly higher.