Midgut malrotation as a rare cause of
chronic abdominal pain: a case report
and review of literature
A. Bajwa, H. Sheth and F. Hughes
Corresponding address:
Adeel Bajwa, BSc, MBBS, MRCS,
Surgical & Anaesthesia Directorate,
The Royal London Hospital, 2nd Floor West Wing,
London, E1 1BB, UK.
E-mail: adeelahmadbajwa@hotmail.com
Abnormalities in midgut rotation occur during the physiological herniation of the midgut between
the 5th and 10th week of gestation. The most significant abnormality is a narrow small bowel
mesentery which is prone to volvulus. This occurs most frequently in the neonatal period.
Less commonly, midgut malrotation presents in adulthood with either acute volvulus or
chronic abdominal symptoms. It is the latter group that represents a diagnostic challenge.
We report a case of a 31-year-old female patient who presented with a 6-year history of
non-specific gastro-intestinal symptoms. After extensive investigation the patient was diagnosed
with midgut malrotation following an upper gastro-intestinal series. The patient was treated with
a laparoscopic Ladd’s procedure and at 3 months was gaining weight and had stopped vomiting.
A laparoscopic Ladd’s procedure is an acceptable alternative to the open technique in treating
symptomatic malrotation in adults.
Keywords
Malrotation; adult; Ladd's; laparoscopic; chronic; classification.
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