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Abstract
Two cases of acute intestinal obstruction in adults caused by a nonrotation anomaly of the bowel are presented. Both of the patients had suffered since chilhood from chronic, recurrent but rather mild abdominal symptoms which subsided spontaneously. In both cases volvulus of the cecum caused the acute abdominal condition, necessitating emergency operation. The nonrotation anomaly was an unsuspected discovery at laparotomy. The possibility of this type of congenital anomaly should be kept in mind whenever a patient has chronic recurrent abdominal symptoms or an acute abdominal condition.
... The anomaly can provoke colonic volvulus in any segment of the large intestine at adulthood, and emergency surgery is needed. However, the prevalence and favored site of the colonic volvulus in adulthood is unclear, with limited case reports [7,[9][10][11][12][13][14], and no case of recurrence at different segments has been reported. Every surgeon should know that an anomaly of the intestinal rotation is not only a pediatric disease but that adult patients can also be affected [15]. ...
Background:
Intestinal nonrotation is a rare congenital condition that causes fatal colonic volvulus at any age. Once volvulus attack occurs, radical surgical therapy is required for treatment and the prevention of recurrence. This report describes the case of an adult female patient with a recurrence of cecum volvulus due to intestinal nonrotation after transverse colon resection for colonic volvulus.
Case presentation:
A 27-year-old female visited our emergency room (ER) with intermittent abdominal pain and nausea. Enhanced computed tomography (CT) showed enlargement of the level of the ascending and transverse colon and an obstruction with a whirlpool sign at the transverse colon. The small intestine was distributed on the right side of the abdominal cavity, and the large intestine occupied the left side. She was diagnosed with volvulus with intestinal nonrotation, and emergency surgery was performed. Surgical examination indicated that the ascending colon to the transverse colon was not fixed to the retroperitoneum, and the transverse colon was rotated 180° clockwise. The axis of the volvulus was a mesenteric adhesion of the transverse colon. The involved transverse colon was resected, and the intestine was reconstructed by functional end-to-end anastomosis (FEEA). Six years after the initial surgery, the patient presented to the ER with abdominal fullness and lower abdominal pain. Enhanced CT revealed that the cecum, ascending colon, and remaining transverse colon were dilated with an obstruction. The appendix was located in the left upper abdominal cavity. The clinical diagnosis was cecal volvulus with intestinal nonrotation. An emergency laparotomy revealed that the cecum was rotated 180° clockwise. The terminal ileum to the remaining transverse colon was resected, and FEEA was performed. Seven months later, she suffered obstruction of the intestine caused by an operative adhesion, and conservative treatment was successful. The patient has had no abdominal symptoms for one and a half years so far.
Conclusions:
Surgeons should realize that nonrotation of the intestines induces volvulus in adulthood and should familiarize themselves with its clinical findings, appropriate treatment, and prognosis. Even after surgical treatment, awareness of the recurrence of volvulus should be maintained to avoid a late diagnosis.
A 24-hour-old Welsh-Thoroughbred foal presented for routine surgical repair of an abdominal and body wall hernia. The colt became acutely colicky and emergency celiotomy was performed revealing abnormal anatomical configuration of the gastrointestinal tract (GIT). Incomplete gastrointestinal rotation is a rare congenital anomaly only described in man. This report describes the clinical and diagnostic findings, surgical and medical treatment, and outcome of a neonatal foal with nonrotation of the GIT.
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