Incidentally Discovered Malrotation in a Case of Gastric Perforation | Chapter 3 | New Visions in Medicine and Medical Science Vol. 8

Aim: The study is a case report of a 36-year-old male with blunt trauma to the abdomen following a road traffic accident, with an intraoperative finding of gastric perforation alongside an incidentally detected malrotation.

Introduction: The term "intestinal malrotation" refers to abnormalities affecting intestinal fixation and intestinal nonrotation or partial rotation around the superior mesenteric artery. Only 0.2 to 0.5% of people exhibit symptoms, with the remainder exhibiting none at all.

Case Presentation: A 36-year-old man arrived at the hospital two days ago with traumatic abdominal damage. Examination results showed that the patient had a blood pressure of 90/60 mmHg, a pulse of 130 bpm, a respiratory rate of 32 breaths per minute, and a saturation of 78% in room air. X-ray chest showed gas under diaphragm. An anterior gastric rupture with a transverse colon below the stomach and a jejunum with small bowel loops present on the right was discovered during an emergency laparotomy. Gastrojejunostomy was done. The patient's postoperative stay went smoothly, and on POD 10, he was discharged, able to resume his regular oral diet and pass stool.

Conclusion: Intestinal malrotation is a rare developmental anomaly of the embryonic gut. In babies, bilious vomiting is the most prevalent presentation; in older children and adults, chronic and sporadic abdominal pain is evident. Surgery is debatable in asymptomatic patients. However, adults with delayed malrotation presentation manifest with varied symptoms. Hence, to prevent further difficulties, a high index of suspicion together with pertinent investigations (CT and USG) is required.

Author(s) Details:

Abhishek Soham Satpathy,
Department of Surgery, S.C.B. Medical College and Hospital, Cuttack, 753007, India.

Please see the link here: https://doi.org/10.9734/bpi/nvmms/v8/8288E

Research on Waugh’s Syndrome in Children: A Problematic Entity | Chapter 7 | Current Topics in Medicine and Medical Research Vol. 1

Case Report: A previously healthy 4.5-year-old boy was admitted to our department with a 6-week history admitted to our department with a 6-week history of intermittent abdominal pain, poor appetite, sporadic nonbilious vomiting, and occasional constipation. A weight loss of five kilograms since the onset of symptoms was reported. On admission, the weight of the patient was 15 kg, as opposed to 20 kg six weeks earlier. Physical examination revealed a soft and mildly distended abdomen. A palpable, tender, round mobile mass was detected at the epigastrium. The white blood cell count was 11.000/μL (normal range, 4.500–9.900/μL), hemoglobin was 12.1 g/dL, and platelets were 420.000/μL. The serum chemistry profile was within normal limits, apart from C-reactive protein of 0.8 mg/mL (normal range, 0– 0.5 mg/mL). Abdominal ultrasonography in transverse view revealed alternating hypoechoic and hyperechoic bowel walls suggesting the target sign (Fig. 1). Hydrostatic reduction was attempted, without success (Fig. 2). Exploratory laparotomy through a right upper quadrant transverse incision revealed an ileocolic intussusception extending up to the transverse colon (Fig. 3(a)). The duodeno-jejunal junction was found to be on the right of the superior mesenteric vessels; the ileocecal junction was freely mobile and the colon was suspended by primitive mesenteric folds. Furthermore, well-defined Ladd’s bands were seen to extend from the ascending colon to the posterior abdominal wall across the duodenum (Fig. 3(b)). The intussusception was manually reduced, and no leading point was found. Ladd’s procedure was also performed including appendicectomy. The child had an uneventful recovery. Six months after the operation he was well without any further abdominal symptoms and had gained weight. A 4.5 –year-old boy with clinical presentation and intraoperative findings described above has a chronic intussusception with intestinal malrotation that could possibly represent a variation of Waugh’s syndrome (WS). WS is usually the association of acute intussusception with intestinal malrotation. This chapter will review the history, epidemiology, pathogenesis, terminology, diagnostic evaluation and management options of acute intussusception, intestinal malrotation, chronic intussusception and WS. 

Author(s) Details

George Vaos
 Department of Pediatric Surgery, School of Medicine, “Attikon” General Uniiversity Hospital, National and Kapodistrian University of Athens, Athens, Greece.

Nick Zavras  
Department of Pediatric Surgery, School of Medicine, “Attikon” General Uniiversity Hospital, National and Kapodistrian University of Athens, Athens, Greece.

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