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Background: Intestinal Malrotation is congenital that complicates 1 in every 200 births. It results from abnormal fixation and rotation of the gut tube during fetal development. It is usually asymptomatic and most cases are diagnosed during childhood and the condition is seldom seen in adults. Also, it can present as an incidental finding in imaging or patients undergoing laparotomy for other reasons. Midgut Volvulus can lead to small obstruction it warrants surgical intervention. Case presentation: Our case is a 20 years old black African male from Khartoum (Sudan) who presented to the emergency department with features of intestinal obstruction he was resuscitated and underwent a CT scan of the abdomen that showed malrotation of the intestine with volvulus for which he underwent a Ladd procedure. Conclusion: Small bowel obstruction due to volvulus complicating malrotation is a rare presentation in adulthood and the Ladd procedure can be utilized to manage such case. [ABSTRACT FROM AUTHOR]

Background: Despite the prevalence of intestinal malformation in Childs, late-onset during adulthood is rare and usually diagnosed incidentally. It may be present as subtle or vague abdominal pain following mid-gut volvulus. Computerized tomography may help diagnosis, but surgery remains the gold standard of diagnosis and treatment. Case Presentation: We presented a 24-year-old woman who complained of chronic intermittent abdominal pain, progressive food intolerance, and severe weight loss. Magnetic resonance enterography revealed dilated jejunum and collapsed ileum with slight bowel rotation around its mesentery (whirlpool sign), which was suggestive for mal-rotation of the intestine complicated by midgut volvulus, then the diagnosis was confirmed by laparotomy. During six months of follow-up after surgery, the patient's appetite improved significantly with eight kilograms of weight gain and resolution of abdominal pain. Conclusion: It may be a rationale to consider intestinal malformation as a differential diagnosis in a patient who complained of chronic abdominal pain with progressive weight loss, anorexia, and recurrent bowel obstructive symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Acute appendicitis is one of the most frequent intra-abdominal diseases requiring emergency surgical consult and treatment. The diagnosis of this condition is based on clinical features and radiologic findings. One-third of patients with acute appendicitis present unusual symptoms. There are several circumstances that may cause misdiagnosis and unclear prognostic prediction. Among these, situs viscerum inversus totalis and midgut malrotation can be challenging scenarios, leading to a delay in treatment, especially when these conditions are unknown. We decided to carry on a systematic review of published cases of acute appendicitis in the context of anatomical anomalies. Methods: We used the MESH terms "appendicitis" AND "situs inversus" AND/OR "gut malrotation" to search for titles and abstracts. Inclusion criteria were patients with clinical and/or radiological diagnosis of acute appendicitis, with conservative or surgical management and with preoperative/intraoperative findings of situs viscerum inversus or gut malrotation. Additionally, previous reviews were examined. Exclusion criteria of the studies were insufficient patient clinical and demographic data. Results: We included in this review 70 articles concerning 73 cases of acute appendicitis with anatomical anomaly. Patients were aged from 8 to 86 years (median: 27.0 years). 50 were male and 23 were female. 46 patients (63%) had situs viscerum inversus, 24 (33%) had midgut malrotation, 2 (2.7%) had Kartagener's syndrome, one of them (1.4%) had an undetermined anomaly In 61 patients the anatomical anomaly was unknown previously (83.6%), while 16,4% already were aware of their condition. Conclusion: Acute appendicitis can occur in association of rare anatomical anomalies and in these cases diagnosis can be challenging. Situs viscerum inversus and midgut malrotation should always be considered in the differential diagnosis of a patient with left lower quadrant pain, especially in younger population. Besides clinical features, it is fundamental to implement the diagnostic progress with radiological examination. Laparoscopic approach is useful to identify and treat acute surgical emergency and it is also a diagnostic tool and can be tailored in order to offer the best exposition of the operatory field for each single case. [ABSTRACT FROM AUTHOR]

Midgut malrotation is a congenital anomaly due to partial or complete failure of rotation of the midgut in fetal life. Majority of the cases present in the neonatal period and 90% within the first year. Adult presentation is rare and the true incidence is unknown as some cases pass undiagnosed. Whirlpool sign is pathognomic for midgut malrotation and management involves surgery. [ABSTRACT FROM AUTHOR]

Adult midgut malrotation with volvulus (AMMV) is an uncommon presentation which may be found incidentally during abdominal radiologic investigations or at laparotomy. We report a case of AMMV and small bowel gangrene in a 35-year-old Gravida four, Para three at 39 weeks, 4 days gestation who presented with a short history of worsening abdominal pain, repeated vomiting and abdominal wall guarding. Emergency caesarean section performed on account of a suspected placental abruption incidentally revealed a long segment of non-viable small intestine. Subsequent midline laparotomy disclosed a midgut malrotation with volvulus and bowel gangrene. This resulted in a 4.6m resection of non-viable small bowel with Ladd's procedure. The patient developed moderate symptoms of short bowel syndrome in the post-operative period which was successfully managed non-operatively. This case report represents a rare diagnosis, in the West-African sub-region, of an adult midgut malrotation with volvulus mimicking a third trimester obstetric emergency. [ABSTRACT FROM AUTHOR]

Kabuki syndrome (KS) is a rare heterogeneous phenotypic genetic syndrome, characterized by hypotonia, developmental delay and/or intellectual disability with typical facial features. It is challenging to diagnose KS in newborn and young infant. We report a Thai girl who presented with two rare co‐occurrence phenotypes, hyperinsulinemic hypoglycemia and midgut malrotation. She had not have distinctive facial dysmorphism during neonatal period. At 4 months of age, she had poor weight gain with some facial features suggestive KS. Singleton whole exome sequencing (WES) was carried out followed by Sanger sequencing of the supposed variant. The result indicated a novel de novo heterozygous KMT2D mutation, c.15364A>T (p.Lys5122*), confirming KS. Our patient revealed rare clinical manifestations from the diverse population and address the benefit of WES in establishing early diagnosis of KS before typical facial gestalt exhibited, which allows timely and appropriate management to maximize developmental achievement. [ABSTRACT FROM AUTHOR]

Introduction: Adult midgut malrotation is very rare. The presentation in adults is mostly subtle; the diagnosis is often made on imaging. Case report: A 32-year-old man presented with a 3-day history of an irreducible painful mass protruding per rectum, followed by abdominal pain and constipation. The patient was febrile and toxic, with marked signs of peritonitis and complete fullthickness irreducible rectal prolapse. Abdominal radiographs showed multiple air-fluid levels. A diagnosis of irreducible rectal prolapse with intestinal obstruction was made. Laparotomy revealed complete small bowel gangrene, abnormal rotation of the small bowel 180° around the mesenteric root, hypermobile duodenojejunal flexure and ileocaecal junction and an abnormally mobile caecum lying in the central abdomen. Abnormal mobility of the sigmoid colon with a large mesocolon, and a large irreducible rectosigmoid intussusception, was also noted. Our patient is probably the first case in literature, which may prompt awareness of simultaneously-occurring disorders of fixation, and preventive steps. [ABSTRACT FROM AUTHOR]

Acute appendicitis is one of the most common surgical conditions that are diagnosed with acute abdominal pain in the emergency department. Atypical location of the appendix as in left-sided appendicitis has an increased risk of delayed diagnosis and mortality. The appendix varies in its location according to the position of the cecum. We reported a case of a 75-year-old previously healthy man with left-sided acute appendicitis (LSAA) to increase the awareness in the management of this atypical and variant condition. In addition to detail descriptions of the case report, we reviewed the current literature for LSAA provided in this article. [ABSTRACT FROM AUTHOR]

Midgut malrotation is a congenital condition resulting from incomplete normal intestinal rotation after physiologic gut herniation. While it can remain asymptomatic over an entire lifetime, midgut volvulus is most likely to occur during early life. While an upper gastrointestinal series is the imaging modality of choice for definitive diagnosis, sonography is a safe and effective modality capable of indicating midgut malrotation, especially in pediatric patients. This case study illustrates the sonographic findings associated with intestinal malrotation with volvulus and discusses the etiology, signs, symptoms, and treatment of the condition. In addition, the sonographic findings are correlated with upper gastrointestinal results, which confirmed midgut malrotation. The diagnosis of volvulus secondary to midgut malrotation was confirmed by a laparoscopic Ladd procedure performed to treat the neonate. [ABSTRACT FROM AUTHOR]

Malrotation of the midgut is generally considered as a pediatric pathology with the majority of patients presenting in childhood. The diagnosis is rare in adults, which sometimes leads to delay in diagnosis and treatment. An index of suspicion is therefore required when dealing with patients of any age group with abdominal symptoms. We present a case of a 26-year-old male who presented with left lower abdominal pain with preoperative computed tomography showing suspected left-sided appendicitis associated with midgut malrotation. The duodenum, small bowel, and cecum were abnormally located, with the presence of a thickened and inflamed appendix with fecalith images. The patient underwent an emergency laparotomy, and ruptured cecal diverticulitis with abscess formation was confirmed. We performed a cecectomy, and the patient did not have an uneventful postoperative recovery. A review of the literature is presented to highlight the rarity of midgut malrotation and the controversies surrounding its surgical management in the adult population with ruptured left-sided cecal diverticulitis. [ABSTRACT FROM AUTHOR]

Aim-Background: Acute presentation in adulthood of the indolent developmental midgut malformations constitutes a diagnostic problem and emergent surgery may result to an operative surprise. Methods: In the last five years two women (case I: 46 years, case II: 88 years) and two men (case III: 42 years, case IV: 50 years) underwent urgent laparotomy for acute abdomen due to bowel obstruction (all cases) and peritonitis (cases II, III). Right colon volvulus in cases I, II and IV, ileocolonic intussusception in case II, gaseous distension of bowel loops and abdominal abscess in case III, and enlargement of the entire colon and megasigmoid in case IV were revealed by preoperative imaging. Symptoms of severe abdominal pain, abdominal distension with tenderness, vomiting and complete constipation were evident in all cases. At surgery, features of malrotation, mainly lack of fixation of the right colon which was volvulised, were found in all cases. Right-sided small intestine and Meckel's diverticulum abscess were found in case III, and an incompletely volvulised megasigmoid coexisted in case IV. We performed resection of peritoneal bands, right hemicolectomy with ileotransversostomy in cases I, II and IV, and enterectomy and right colon fixation in case III. A Hartmann's sigmoidectomy completed the operation in case IV. Results: All cases had uneventful outcome, except for some delay in wound healing in a diabetic patient. Histology revealed ischaemia in all segments excised, ileocolonic intussusception associated with a caecal adenocarcinoma in case II, and inflammed Meckel's diverticulum in case III. Conclusions: Adult bowel malrotation complicated with right colon volvulus and/or ileocolonic intussusception requires emergent surgery. [ABSTRACT FROM AUTHOR]

Intestinal malrotation is a developmental anomaly characterized by a midgut fixation disorder and failure to complete its normal fetal rotation around the superior mesenteric artery inside the peritoneal cavity. Malrotation is a rare cause of mechanical intestinal obstruction in adults. It may manifest as an emergency condition or with chronic abdominal symptoms. Although its diagnosis remains difficult, early diagnosis and treatment usually yield favorable outcomes. Intestinal malrotation rarely has an asymptomatic course, in which the diagnosis is usually made incidentally. Multislice computed tomography is quite helpful for making a correct diagnosis. In this study, we reported a 56-year-old patient incidentally who was detected to have intestinal malrotation and was managed symptomatically after presenting at our clinic with signs and symptoms of intestinal obstruction; we also provided a discussion of the relevant literature. [ABSTRACT FROM AUTHOR]

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Background: Situs inversus (SI) and midgut malrotation (MM) are uncommon anatomic anomalies that complicate diagnosis and management of acute abdominal pain.Methods: We present two cases of left-sided acute appendicitis with situs inversus totalis and a literature review of studies published in English language on left-sided acute appendicitis, accessed via Pubmed and Google Scholar database.Results: Sixty-three published cases of left-sided acute appendicitis were evaluated, and two patients (M:16 yr, F:17 yr) who presented to our clinic with left lower quadrant pain caused by left-sided acute appendicitis were reported. Thirty-five of the patients were male and 30 were female (including our patients) with age range from 8 to 63 years and median age of 26.7 +/- 14.0 years. Fifty-three patients had situs inversus totalis (SIT), 8 had MM and two were with malrotation of the caecum. Thirty-eight patients had applied to the hospital with left lower quadrant pain, 12 with right and 6 with bilateral lower quadrant pain. Thirty patients were diagnosed as having SIT or MM, while the diagnosis in 12 patients was established during the intraoperative period. Eleven patients with SIT were aware of having this anomaly. Five of the patients underwent laparoscopic appendectomy and in two patients laparoscopic appendectomy and cholecystectomy were performed in one session. Preoperative diagnosis has been easier to achieve after 1985, when ultrasonography (USG) and computed tomography (CT) were introduced into the medical practice.Conclusion: SIT and MM should be taken into consideration in patients with findings of the physical examination suspicious for left-sided acute appendicitis. X-ray, USG, CT and diagnostic laparoscopy are beneficial in developing the differential diagnosis. [ABSTRACT FROM AUTHOR]

Appendicitis is a common surgical abdominal disease with various presentations. Its diagnosis may be obscured by asymptomatic congenital anatomical anomalies like midgut malrotation. Midgut malrotation is a rare fetal anomaly resulting from incomplete or failure of midgut rotation and fixation. It is mostly presented with bowel obstruction or volvulus in early life. Presentation in adult is rare. Here, we report an elderly patient presented with left lower abdominal pain and urinary tract infection. Abdominal computed tomography revealed left-sided appendicitis with non-rotational-type midgut malrotation. Clinicians should bear in mind the possibility of underlying midgut malrotation, as appendicitis could be the first presentation of this rare congenital condition. [ABSTRACT FROM AUTHOR]

Midgut malrotation includes a range of developmental abnormalities that occur during fetal intestinal rotation. Manifestations of intestinal malrotation are generally seen in the paediatric population and are uncommon in adults. Symptomatic patients may present with either acute abdominal pain due to midgut volvulus, or chronic abdominal pain due to proximal midgut partial obstruction in the presence of congenital bands. A limited number of paediatric cases of duodenal occlusion due to duodenal malrotation has been previously reported in the medical literature. We herein report the case of a 57-year-old woman who presented with duodenal obstruction due to organoaxial partial rotation of the distal duodenum associated with midgut malrotation. This is probably the first of such a case diagnosed in adulthood reported in the medical literature. Our patient underwent Roux-en-Y duodenojejunostomy and had symptomatic relief following the successful surgery. [ABSTRACT FROM AUTHOR]

Midgut malrotation is a rare anatomic anomaly that complicates the diagnosis and managemant of acute abdominal pain. It is a congenital anomaly that arises from incomplete rotation or abnormal position of the midgut during embryonic development. We report a case of a patient who have very rare form (Nonrotation of the proximal loop associated with partial rotation of the distal loop) of malrotation with ruptured appendicitis. Left-sided acute appendicitis should be considered in the differential diagnosis of patients with pain with localized in the left lower quadrant. [ABSTRACT FROM AUTHOR]

The article describes the case of a 47-year-old female who experienced midgut malrotation (MM) while undergoing laparoscopic Roux-Y gastric bypass. MM is considered a rare congenital anomaly resulting from the abnormal rotation of the primitive midgut loop around the superior mesenteric artery (SMA). The clinical management administered to the patient is described. Clinical information on MM is also presented.

Malrotation and Hirschsprung's disease (HSD) are rarely reported together. We report our experience with three patients who presented during the neonatal period in whom the association resulted in diagnostic difficulty. In this report, we focus on the clinical presentation, diagnosis and appropriate management. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 20-year-old man who was presented with a sudden onset of abdominal pain and vomiting of 3 hours duration. This case of malrotation with volvulus is a well-recognized condition presenting with bowel obstruction in the neonate and the young child. It is rarely seen in the adult. Incidence of rotational anomalies in the adult is not well documented. Clinical examination revealed a distressed male with generalized abdominal tenderness without guarding. Serum electrolytes, liver function tests and amylase were within normal limits.