Case Report
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World J Gastrointest Surg. Mar 27, 2013; 5(3): 43-46
Published online Mar 27, 2013. doi: 10.4240/wjgs.v5.i3.43
Recurrent intestinal volvulus in midgut malrotation causing acute bowel obstruction: A case report
Fayed Sheikh, Vickna Balarajah, Abraham Abiodun Ayantunde
Fayed Sheikh, Vickna Balarajah, Abraham Abiodun Ayantunde, Department of Surgery, Southend University Hospital, Westcliff-on-Sea, Essex SS0 0RY, United Kingdom
Author contributions: Sheikh F, Balarajah V and Ayantunde AA conceived the write up, performed the literature search and manuscript preparation; Ayantunde AA performed the operation, involved in the preoperative and postoperative care; all authors read and approved the manuscript for submission.
Correspondence to: Abraham Abiodun Ayantunde, MBBS, FRCS, FWACS, FRCS, Department of Surgery, Southend University Hospital, Prittlewell Chase, Westcliff-on-Sea, Essex SS0 0RY, United Kingdom.
Telephone: +44-170-24355555 Fax:+44-170-2385856
Received: November 1, 2012
Revised: January 20, 2013
Accepted: January 29, 2013
Published online: March 27, 2013

Intestinal malrotation occurs when there is a disruption in the normal embryological development of the bowel. The majority of patients present with clinical features in childhood, though rarely a first presentation can take place in adulthood. Recurrent bowel obstruction in patients with previous abdominal operation for midgut malrotation is mostly due to adhesions but very few reported cases have been due to recurrent volvulus. We present the case of a 22-year-old gentleman who had laparotomy in childhood for small bowel volvulus and then presented with acute bowel obstruction. Preoperative computerised tomography scan showed small bowel obstruction and features in keeping with midgut malrotation. Emergency laparotomy findings confirmed midgut malrotation with absent appendix, abnormal location of caecum, ascending colon and small bowel. In addition, there were small bowel volvulus and a segment of terminal ileal stricture. Limited right hemicolectomy was performed with excellent postoperative recovery. This case is presented to illustrate a rare occurrence and raise an awareness of the possibility of dreadful recurrent volvulus even several years following an initial Ladd’s procedure for midgut malrotation. Therefore, one will need to exercise a high index of suspicion and this becomes very crucial in order to ensure prompt surgical intervention and thereby preventing an attendant bowel ischaemia with its associated high fatality.

Keywords: Gut volvulus, Intestinal malrotation, Acute bowel obstruction, Computerised tomography scan, Laparotomy