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15 November 2018 : Case report  Lebanon

An Unusual Case of Intestinal Malrotation Causing Duodenal Obstruction by a Looped Appendix

Challenging differential diagnosis, Management of emergency care, Congenital defects / diseases

Hussein Hmadeh1ABEFG, Christian Saliba2ABDEFG*, Mohamad Raka1BG, Hammam Ahmad Farhat1ABDEG, Ali Dabbous1G, Samer Diab2FG, Layan Abbas3G, Ali Wehbe4ABCEFG

DOI: 10.12659/AJCR.913039

Am J Case Rep 2018; 19:1362-1365

Abstract

BACKGROUND: Bowel obstruction is a mechanical or functional obstruction of the intestines which prevents the normal movement of the products of digestion. Intestinal malrotation is one of the rarest causes of mechanical bowel obstruction. In adults, the incidence rate is 0.2%, and 15% of all patients with confirmed diagnosis remain asymptomatic throughout life. Surgery is generally required when the patient is symptomatic.

CASE REPORT: A 30-year-old man with multiple admissions for chronic intermittent colicky abdominal pain since childhood, was admitted for symptoms suggestive of proximal small bowel obstruction. Tomographic imaging identified a midgut malrotation and a duodenal obstruction by a non-diseased displaced appendix. Laparoscopic liberation of the duodenum and the terminal ilium was done successfully.

CONCLUSIONS: Intestinal malrotation is infrequently encountered in the adult population, but it should be kept in mind as a differential diagnosis whenever a case of acute intestinal obstruction in an adult presents without any significant past surgical history.

Keywords: Duodenal Obstruction, Intestinal Obstruction, Upper Gastrointestinal Tract

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923