Malrotation of the intestine is seen mostly in infants, and is rarely found after adolescence. This paper describes our recent experience with a case of malrotation with midgut volvulus diagnosed by visual examinations in adolescence after long-term abdominal symptoms.
A 17-year-old man was seen at the hospital because of abdominal pain. The cecum and ascending colon were found to be located at the mid-upper abdomen by a barium enema examination. Abdominal enhanced CT scan revealed SMV rotation sign and a whirlpool sign. The patient was diagnosed as having malrotation with volvulus and was operated on. At operation, the patient was found to have a mlrotation with non-rotation of the midgut and with two sites of volvulus. Respective volvulus had taken place in a clockwise direction by 360 degrees. First, each volvulus was untwisted in the opposite direction. Then the Ladd's technique was carried out, followed by an appendectomy. He has been doing well without any symptoms after the operation.
Although the both malrotation and volvulus are quite rare, we would be able to diagnose the diseases by the presence of characteristic pictures on various imaging examinations.
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)