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  • Midgut volvulus in a pediatric patient with chronic constipation, congenital intestinal malrotation and internal transmesocolic hernia

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Case Reports: Reminder of important clinical lesson
Midgut volvulus in a pediatric patient with chronic constipation, congenital intestinal malrotation and internal transmesocolic hernia
  1. Emily Brezler1,
  2. Rita Sico2 and
  3. Federico G Seifarth1
  1. 1Department of Surgery, Division of Pediatric Surgery, WVU Medicine Children's Hospital, Morgantown, West Virginia, USA
  2. 2Pediatric Radiology, WVU Medicine Children's Hospital, Morgantown, West Virginia, USA
  1. Correspondence to Dr Federico G Seifarth; Federico.seifarth{at}gmx.net

Abstract

Congenital intestinal malrotation occurs in 1 of 500 newborns and can predispose patients to intestinal volvulus and internal herniation, putting patients at risk for intestinal ischaemia. A male patient in early childhood with a history of severe constipation presented with acute abdominal pain, progressing rapidly to compensated shock. CT scan was suspicious for small bowel ischaemia and superior mesenteric artery compression. He underwent emergency exploratory laparotomy. Intraoperative findings were significant for partial intestinal malrotation with mobile ascending colon and high-riding caecum, and internal herniation with midgut volvulus of the ascending colon through a mesenteric defect in the proximal transverse colon. Derotation of the volvulus, reduction of the internal hernia, resection of necrotic segments of the bowel and a modified Ladd’s procedure were performed. Postoperatively, the patient is total parenteral nutrition (TPN) dependent due to short bowel syndrome. A high index of suspicion with prompt imaging is paramount for paediatric patients with symptoms indicating intestinal obstruction.

  • Surgery
  • Paediatric Surgery
  • Paediatrics
  • Congenital disorders

https://doi.org/10.1136/bcr-2022-254425

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    Footnotes

    • Contributors EB reviewed the patient chart and was the main author and wrote the majority of the case report. RS is the radiologist for the patient, and she described the original findings on CT imaging as noted in the case report. She constructed the CT imaging, highlighting the areas of importance. FS is the physician who operated on and cared for the patient, and he provided edits and wrote portions of the case report. He is the senior author.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.