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WJOLS

SY Lim et al 10.5005/jp-journals-10033-1282
CaSe RepORt

Laparoscopic Management of a Volvulus Secondary

to Midgut Malrotation in an Adult with an Incidental
Meckel’s Diverticulum

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1 SY Lim, Tikfu Gee, Zubaidah Hanifah
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ABSTRACT INTRODUCTION
Volvulus is the twisting of the intestine around the axis of Malrotation of the midgut is a congenital condition due
its mesentery resulting in ischemia and eventual gangrene.
Among the pediatric population, volvulus is common due to to an embryonic anomaly in the fetal gut rotation occur­
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midgut malrotation. However, this is a rare etiology of volvulus ring in about 1 in 500 live births. The exact incidence is
among adults. Unlike in the pediatric population, midgut unknown as some cases are asymptomatic. It is usually
malrotation in an adult does not present typically with bilious present in the first month of life and remains an impor­
vomiting. The symptoms are often nonspecific and commonly
manifest as chronic abdominal pain which may be mistakenly tant cause of volvulus and intestinal obstruction in the
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diagnosed as acute gastritis or cholecystitis. A 25-year-old pediatric age group. Symptoms include abdominal
man presented with a sudden episode of abdominal pain, distension, cramp­like pain, and vomiting.
distension, and vomiting. Abdominal X-ray and computed Some cases rarely remain undetected until adult life,
tomography scan revealed dilated small bowel and a high
location of the vermiform appendix. There were ascites but although the majority of them are incidentally diagnosed
no pneumoperitoneum. A diagnostic laparoscopy was then during imaging or abdominal surgery for other unrelated
performed, as the cause of the intestinal obstruction could not conditions. A minority of adult malrotation present
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be determined. The small intestine was grossly dilated until the
distal ileum, where the jejunum was twisted along its mesenteric with either acute or chronic abdominal pain, bloatedness,
axis several times. A short segment of the jejunum appeared and distension. Most of the time, surgeons mistakenly
gangrenous. The terminal ileum was completely collapsed, diagnose these patients as having acute gastritis or
and a Meckel’s diverticulum was incidentally discovered. The cholecystitis.
twisted jejunum was rotated counterclockwise laparoscopically
while freeing the adhesions around it. A limited enterectomy Volvulus is the twisting of the intestines around the
with primary anastomosis was made using staplers. The axis of its mesentery. It may be intermittent and readily
postoperative period was marked by a brief period of ileus, untwist on its own, or the condition may persist to the
but the patient was discharged well a week after the surgery. point of strangulation and gangrene. In the adult, volvu­
Volvulus and intestinal obstruction in a young adult may
occasionally have a congenital etiology. Although intestinal lus is either primary or secondary to adhesions, bands,
obstruction is a relative contraindication for laparoscopy, it may or congenital malrotation.
be feasible in the early presentation of obstruction especially We reported a case of an acute volvulus secondary to
where a preoperative diagnosis is uncertain.
a midgut malrotation with an incidental Meckel’s diverti­
Keywords: Laparoscopy, Meckel’s diverticulum, Midgut culum in an adult with the diagnosis made preoperatively
malrotation, Volvulus.
with a computed tomography (CT) scan and managed
How to cite this article: Lim SY, Gee T, Hanifah Z. using the laparoscopic approach.
Laparoscopic Management of a Volvulus Secondary to Midgut
Malrotation in an Adult with an Incidental Meckel’s Diverticulum.
World J Lap Surg 2016;9(2):98-100. CASE REPORT
Source of support: Nil A 25­year­old man presented to the emergency de­
Conflict of interest: None partment with an acute episode of abdominal pain,
distension, and vomiting. He had similar complaints
throughout the year before, and his attending surgeon
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1 Trainee Lecturer, Head, Senior Lecturer and Consultant diagnosed him with repeated episodes of acute cholecys­
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1-3 Department of Surgery, Universiti Putra Malaysia, Serdang titis. Incidentally, he had gallstones, and he underwent
Selangor, Malaysia laparoscopic cholecystectomy. During the operation,
Corresponding Author: SY Lim, Trainee Lecturer, Department the surgeon had then found a “congenital anomaly of
of Surgery, Universiti Putra Malaysia, Serdang, Selangor the intestine” but did not proceed to correct or further
Malaysia, Phone: +0123302008, e-mail: surgeryupm@gmail.com
diagnose the condition.

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