Intestinal Mal-rotation in an adult male: case report and literature review
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Abstract
Introduction: intestinal mal-rotation is widely considered paediatric pathology where the vast majority of presentation would occur. In the paediatric population this condition has an incidence rate of about 1 in 500 live births (7) in which 75% to 85% of these are diagnosed within infancy. The adult population presentation is an increasing form in which in several studies conducted by Nehra et al, and Kotobi et al, and have shown a prevalence rates of 48% (1) and42% (2) respectively. Although according to other studies the true incidence in the adult population is difficult to calculate (23). This is partially due to the fact that a significant proportion may remain asymptomatic throughout their lives (24) and the rest are diagnosed intra-operatively during other procedures or at autopsy (25).
Method: This case of a 36 year old male patient well-nourished and average height was hospitalised with a presenting complaint of abdominal pain for one day. This patient had a Past medical history of asthma with the last attack a week prior to this presentation. On physical examination was found to be afebrile and haemodynamically stable. The abdominal findings were distension and generalised tenderness. There were no mass or organomegally on palpation however there was brown stool and scant blood on digital rectal examination. A nasogastric tube was sited. The urinary catheter was not cited as this patient had urethral strictures. Strict input and out charting were done along with timely monitoring of vital signs. The laboratory investigations were found to be within normal range. The abdominal radiographic findings were multiple air fluid levels on erect view and dilated loops of bowel on the supine view.
Results: This patient was resuscitated with intravenous fluid therapy, analgesia, prophylactic antibiotic along with deep vein thrombosis prophylaxis and booked for exploratory laparotomy. Intra-operatively Ladd’s bands with a mal-rotated intestine were found. Ladd’s procedure and supra-pubic cystostomy were done. The patient had an uneventful postoperative period and was discharged home on day 5th post-op with regular surgical outpatient follow up.
Conclusion: This late presentation of a congenital pathology such as intestinal mal-rotation can be a diagnostic and therapeutic challenge. Therefore the need to include this as an armament in the diagnostic differentials in an adult with vague abdominal complaint is essential to avoid any surgical catastrophe. The Ladd’s procedure is the current gold standard.
Keywords
Mal-rotation, Intestinal volvulus, Ladd’s procedure
References
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