Massive intestinal infarction due to volvulus in congenital malrotation: A case study

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Case history We present the case of a young girl with a total small bowel volvulus in congenital malrotation. Clinical Findings The patient had multiple admissions to the emergency room in the previous 8 years for the same symptoms, discharged every time with diagnosis of abdominal cramping. Investigation/results FBC and ABG showed leucocytosis (WBC 20.9), anaemia (HGB 5.6), ARF (sCr 1.9 mf/dL), severe metabolic acidosis (pH 7.08) and high lactates level (20 mmol/L). Patient showed abdominal distension, diffuse pain and early sign of peritonism. A contrast enhanced CT scan highlighted ascending and transverse colon swelling and SMA-SMV blockage 3cm from its origin. Diagnosis A diagnosis of intestinal volvulus was made with necessity of emergency surgical intervention. Therapy and progression We performed an exploratory laparotomy with finding of vast necrosis of the whole small intestine from 80cm for the Treitz ligament, to the distal third of the transverse colon. Therefore, we resected the whole necrotic tract "en bloc" and performed a right lower quadrant ileostomy. The patient recovered bowel function through ileostomy on the 10th day and the NG tube was removed on the 13th day. She was followed-up by the clinical nutrition specialists that diagnosed IFALD due to the TPN and SBS. Patient was discharged on the 30th day and after 2 months underwent successful re-channelling operation. Comments This case highlights the need to think about congenital malrotation in the differential diagnosis of a patient presenting recurrent abdominal pain with multiple admission to the ER and negative or unclear examinations. As a matter of fact, it could allow physicians to early identify this condition in order to perform a Ladd"s procedure before the onset of necrosis in the case of a total small bowel volvulus. References A.T. Fung,et al Malrotation with midgut volvulus in an adult:a case report and review of the literature IJSCR 2017;5, 1–3

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