J.Jpn. Surg. Soc.. 119(6): 629-635, 2018

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Feature topic

MIDGUT VOLVULUS ASSOCIATED WITH INTESTINAL MALROTATION : PITFALLS IN EARLY DIAGNOSIS

Congenital intestinal malrotation is a pathological condition in which the rotation and fixation of the midgut in the early fetal period are disrupted. As a result, the long mesenteric root for fixation of the small intestine does not form. On the contrary, the midgut area supplied with blood from the superior mesenteric artery (SMA) is suspended at the narrow base of the SMA, and this anatomical abnormality enables the sudden onset of gangrenous volvulus. Therefore, midgut volvulus induces the severe clinical condition of short bowel syndrome. A wide variety of types of malrotation can occur. The pathological type is the so-called 180-degree rotation type due to the possible occurrence of gangrenous midgut volvulus. In neonates, bilious vomiting and melena are the main symptoms associated with ischemic changes of the bowel, while in late-onset pediatric and adult cases, abdominal pain and vomiting are frequent symptoms, but not associated with ischemic bowel changes. However, there are few reports on adult cases associated with gangrenous volvulus. Therefore, early diagnosis and proper treatment of midgut volvulus in all patients with intestinal malrotation is of the utmost importance in preventing life-long morbidity from short bowel syndrome.

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