The Late Diagnosed Intestinal Malrotation by Abdominal Tomography In An Adolescent

Yıl 2019, Cilt: 10 Sayı: 2, 61 - 64, 01.04.2019

Esra Ozcakır , Serpil Sancar , Gokhan Orcan Mete Kaya

https://doi.org/10.33706/jemcr.551141

Öz

Introduction: Intestinal
malrotation is an anomaly that often manifests in newborn and infant childhood.
This anomaly, which is rarely seen in older children and adults, is usually
detected incidentally during imaging studies or during laparotomy. This article
is presented with the aim of emphasizing the Computarised Tomography (CT)
imaging for intestinal malrotation an adolescent patient with mesenteric
volvulus.

Case Report: A
sixteen-year-old male patient presented with epigastric pain and bilious
vomiting after feeding. In ultrasonography (US), intestinal loops were surrounding
along the superior mesenteric artery (SMA) and venous (SMV) vessels tract. In
CT, it was noted that SMA marks a whirl sign in the midline of the abdomen. At
laparotomy, there were found 360° torsion of small intestine, due to intestinal
malrotation. Ladd procedure was performed.

Conclusion:
In cases of intestinal malrotation, preoperative diagnosis can be difficult
because of the lack of specific findings in the physical examination. The
delayed diagnosis may be lead to volvulus and intestinal necrosis. The
diagnosis of malrotation can brought to mind at an early age but it may be
delayed in later ages. In practiced hand, the evaluation of vessels traseries
by detailed US and contrast-enhanced CT are characteristics of malrotation
diagnosis.

Anahtar Kelimeler

Intestinal Malrotation, Adolescent

Kaynakça

• 1. Pickhardt PJ, Bhalla S. Intestinal Malrotation in Adolescents and Adults: Spectrum of Clinical and Imaging Features. AJR Am J Roentgenol, 2002; 179: 1429-35.
• 2. Başaklar AC, Türkyılmaz Z. Rotasyon Anomalileri. In: Abdullah Can Başaklar, Editor. Bebek ve Çocukların Cerrahi ve Ürolojik hastalıkları. Ankara: Palme Yayıncılık; 2006. p. 505-17.
• 3. Touloukian RJ, Smith EI. Disorders of rotation and fixation. In: O’Neill JA, Rowe M, Grosfeld JL, et al, Editors. Pediatric Surgery. St Louis: Mosby; 1998. p. 1199-214.
• 4. Dinler G, Ceyhan M, Kalaycı AG, Rizalar R. İki buçuk yıllık karın ağrısı öyküsü olan 14 yaşında kız hasta - Ayın Olgusu. Türk Pediatri Arşivi 2008; 43(3): 105-6.
• 5. Belgaumkar A, Karamchandani D, Peddu P, Schulte KM. Small bowel haemorrhage associated with partial midgut malrotation in a middle aged man. World J Emerg Surg 2009; 4: 1-4.
• 6. Duran C, Ozturk E, Uraz S, Kocakusak A, Mutlu H, Killi R. Midgut volvulus: value of multidetector computed tomography in diagnosis. Turk J. Gastroenterol. 2008; 19: 189-92.
• 7. Pracros JP, Sann L, Genin G, Tran-Minh VA, Morin de Finfe CH, Foray P, et al. Ultrasound diagnosis of midgut volvulus: the "whirlpool" sign. Pediatr Radiol. 1992; 22(1): 18-20.
• 8. Horton KM, Fishman EK. The current status of multidetector row CT and three-dimensional imaging of the small bowel. Radiol Clin North Am. 2003; 41(2): 199-212.
• 9. Buranasiri SI, Baum S, Nusbaum M, Tumen H. The angiographic diagnosis of midgut malrotation with volvulus in adults. Radiology 1973; 109: 555-6.
• 10. Fisher JK. Computed tomographic diagnosis of volvulus in intestinal malrotation. Radiology 1981; 140(1): 145-6.