Intestinal malrotation in adults
- Terry Buchmiller, MD
Terry Buchmiller, MD
- Assistant Professor
- Harvard Medical School
Intestinal malrotation occurs when the normal rotation of the embryonic gut is arrested or disturbed during in utero development. While most patients present during the neonatal period or the first year of life , some present as older children or adults [1-3]. (See "Intestinal malrotation in children", section on 'Epidemiology'.)
Because of its rarity, the diagnosis of intestinal malrotation in adult patients is often delayed and therefore associated with increased morbidity [4,5]. The clinical manifestations, diagnosis and treatment of intestinal malrotation in adults will be discussed in this topic. Intestinal malrotation in children is discussed separately. (See "Intestinal malrotation in children".)
Intestinal malrotation occurs as a result of arrested normal rotation of the embryonic gut. As a result, two anatomic variations develop (Ladd bands (picture 1) and narrow mesenteric base (figure 1)), which predispose to symptoms of gastrointestinal obstruction. The pathogenesis is discussed in detail separately. (See "Intestinal malrotation in children", section on 'Embryology and pathogenesis'.)
In neonates, intestinal malrotation almost always presents with acute obstruction or volvulus. However, the clinical presentation of intestinal malrotation in adults is more variable [4,6,7], and some adults are asymptomatic. In asymptomatic patients, malrotation is incidentally discovered by imaging studies obtained for other purposes.
Chronic clinical presentation — Most adults with symptomatic intestinal malrotation present insidiously with one or more of the following features that usually occur during the postprandial period :To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- CLINICAL PRESENTATION
- Chronic clinical presentation
- Acute clinical presentation
- DIAGNOSTIC EVALUATION
- Suggestive imaging studies
- - Plain films
- - Barium enema
- - Abdominal CT
- - Abdominal ultrasound
- Confirmatory imaging study
- - Upper gastrointestinal series
- DIFFERENTIAL DIAGNOSIS
- Differential diagnosis of chronic presentation
- Differential diagnosis of acute presentation
- Treatment of patients with chronic presentation
- Treatment of patients with acute presentation
- Treatment of incidental or asymptomatic malrotation
- SURGICAL OPTIONS
- Open Ladd procedure
- Laparoscopic Ladd procedure
- SUMMARY AND RECOMMENDATIONS