Case presentation An 85-year old male presented with sudden onset central abdominal pain, progressive abdominal distension, diarrhoea, nausea and vomiting. [ncbi.nlm.nih.gov]

Clinical presentation, operative treatment, and outcome were recorded. RESULTS: Nine patients presented with obstructive symptoms (five chronic and four acute). [doi.org]

• Abdominal Pain

  Clinicians should be aware of this rare but serious cause of abdominal pain. [ncbi.nlm.nih.gov]

  We report three cases of laparoscopic correction of adult malrotation presenting with chronic abdominal pain. The diagnosis is made by CT/MRI. [journalofmas.com]

• Bilious Vomiting

  • Bilious vomiting remains the cardinal sign of neonatal intestinal obstruction, and malrotation must be the presumed diagnosis until proven otherwise. 7. • Other signs in the neonate include abdominal pain and distention. • The inconsolable infant [slideshare.net]

  We suggest that such an antenatal finding should alert the paediatrician to close clinical follow-up and prompt the diagnosis and surgical treatment in case of abdominal pain and/or bilious vomiting. [ncbi.nlm.nih.gov]

• Constipation

  In this case, the patient had intermittent constipation and mild abdominal pain, and can be included in the first group previously described. [scielo.br]

  Ultimately, three (two laparoscopic, one open) had persistent symptoms of bloating (n = 2), constipation (n = 2), and/or pain (n = 1). CONCLUSION: Laparoscopic repair appears to be safe and effective in adults. [ncbi.nlm.nih.gov]

  In older children one should consider any cause of intestinal obstruction, vomiting, and acute abdomen, including: Trauma Foreign body ingestion Poisoning Appendicitis Incarcerated inguinal hernia Peptic ulcer disease Constipation Gastroenteritis Urinary [pedclerk.bsd.uchicago.edu]

  They can include: Vomiting green digestive fluid (bile) Drawing up the legs Stomach pain Swollen belly Diarrhea Constipation Rectal bleeding Failure to thrive Fast heart rate Fast breathing Bloody stools The symptoms of malrotation may look like other [stanfordchildrens.org]

• Abdominal Distension

  We report the case of a 14-year-old male patient with bilious vomiting and abdominal distension. A diagnosis could not be made by computed tomography, ultrasonography, or endoscopy. We observed a dilated stomach and malrotation in laparotomy. [ncbi.nlm.nih.gov]

  distension) · Pyloric stenosis (same age group, no bilious vomiting) [learningradiology.com]

  distension in a neonate/infant Signs of bowel ischemia: hematochezia, hematemesis, hypotension, and tachycardia Features of duodenal obstruction: bilious vomiting without abdominal distension Variable presentation in older children/adults: recurrent [amboss.com]

  Abdominal examination revealed moderate abdominal distension, with significant diffuse pain, without acute peritoneal findings. The general physical examination was normal. [scielo.br]

• Blood in Stool

  Abnormal rotation of the GI tract can lead to comprised vascular supply to the affected portions of the intestines and this in turn can cause intraluminal hemorrhage, which manifests as hematemesis (vomiting blood) and/or melena (blood in stools). [news-medical.net]

  These tests may include: Blood tests. Tests to check electrolytes. Stool guaiac. A test to detect blood in stool samples. Computed tomography scan (CT or CAT scan). [chop.edu]

  Some of the other symptoms of Intestinal Malrotation are: Frequent greenish tinged vomiting Abdominal swelling Paleness of skin Decreased appetite No urine output Irregular bowel movements Blood in stools Fever Lethargy. [epainassist.com]

  These tests may include: Blood tests. Tests to check electrolytes. Stool guaiac. A test to detect blood in stool samples. Learn more about stool tests. Computed tomography scan (CT or CAT scan). [choc.org]

• Fracture

  The second case was a 76-year-old woman admitted with multiple fractures and increasing abdominal distension following a fall. [ncbi.nlm.nih.gov]

• Irritability

  The patient described 1 year of self-limited episodes of abdominal pain that improved with defecation and were associated with a change in frequency and consistency of stools that were interpreted as irritable bowel syndrome. [acgcasereports.gi.org]

  Her medical history mentioned an Other Specified Feeding or Eating Disorder (OSFED), Irritable Bowel Disease (IBD) and lactose-intolerance. On physical examination she appeared hemodynamically stable, although cachectic with a BMI of 12kg/m2. [ntvg.nl]

  […] crying every 20-30 minutes due to the recurrent spasms Diarrhea or constipation Vomiting and inability to hold down solid food Failure to thrive (this means that the baby is not growing and gaining weight the way it should) Stomach pain and swelling Irritability [healthstoriesforkids.com]

  They get diagnosed with Irritable Bowel Syndrome (IBS) and get sent home with a crazy concoction of IBS pharmacology. Surgeons don't like these referrals so much. [buckeyesurgeon.com]

  The differential diagnosis includes other causes of vomiting and pain, including peptic ulcers, functional disorders, irritable bowel syndrome or psychiatric disorders 1,5. [scielo.br]

• Vertigo

  Among the patients whose indication was headache, 43% of them had an additional indication such as vision changes, dizziness, or vertigo. [ajnr.org]

• Dizziness

  Among the patients whose indication was headache, 43% of them had an additional indication such as vision changes, dizziness, or vertigo. [ajnr.org]

Workup of these symptoms included computed tomography, which showed small-bowel dilatation along with a whirl sign and numerous collateral veins, suggestive of a midgut volvulus (see video ). [nejm.org]

In patients with chronic symptoms, workup includes a barium or CT /MRI abdomen. Imaging shows small bowel in the right and colon up and to the left [Figure 1] a. [journalofmas.com]

Intestinal Malrotation: Differential Diagnoses & Workup [healthguideinfo.com]

When he lost his medical insurance, he was discharged and advised to have further workup performed elsewhere. [hindawi.com]

Preoperatively, all patients underwent a period of conservative treatment. [ncbi.nlm.nih.gov]

Clinical presentation, operative treatment, and outcome were recorded. RESULTS: Nine patients presented with obstructive symptoms (five chronic and four acute). [doi.org]

Exact incidence, prognosis and surgical implications related to ARM are unknown. The aim of this study was to identify relevant associations between ARM and the presence of malrotation. [ncbi.nlm.nih.gov]

Further Reading Symptoms and Diagnosis of Intestinal Malrotation Symptoms and Diagnosis of Intestinal Malrotation Treatment and Prognosis for Intestinal Malrotation [news-medical.net]

Treatment and prognosis Due to the potential for life-threatening midgut volvulus and ischemic bowel, once discovered malrotation is corrected surgically. [radiopaedia.org]

Although the pathogenesis of fetal primary small bowel volvulus is unclear, ganglion cell immaturity may play a role in the etiology. [ncbi.nlm.nih.gov]

Keywords: Adult, Case Report, Duodenum, abnormalities,Female, Human, Intestinal Obstruction, etiology,Pregnancy, Pregnancy Complications, etiology, How to cite this article: Hardikar J V. Malrotation of the gut manifested during pregnancy. [jpgmonline.com]

They are organised into groups, and further divided into clinical, etiological or histopathological sub-types. [orpha.net]

There are four suggested etiological groups for GI malrotation: (i) abnormal L-R patterning, (ii) dorsal mesentery, (FOXF1) anomalies, (iii) irregularities of the intestine itself, and (iv) abnormalities of other abdominal contents. [news-medical.net]

Epidemiology of intestinal malrotation, Hawaii, 1986–99 First published: 04 April 2003 Cited by: 20 Summary Malrotation of the intestines occurs as a result of failure of normal intestinal rotation and fixation during early pregnancy. [onlinelibrary.wiley.com]

Epidemiology Incidence Volvulus: 3rd most common cause (∼ 10–15%) of intestinal obstruction in the United States Sigmoid volvulus (most common, 80%) Cecal volvulus (15%) Transverse colon volvulus (3%) Splenic flexure volvulus (2%) Intestinal malrotation [amboss.com]

EPIDEMIOLOGY Rotational anomalies occur as a result of an arrest of normal rotation of the embryonic gut. Because rotational anomalies may remain asymptomatic throughout a person’s life span, the true incidence is not known. [uptodate.com]

Epidemiology In the United States, for example, asymptomatic GI malrotation occurs with an incidence somewhere between 1 in 200 to 1 in 500. [news-medical.net]

Pathophysiology Risk factors for the development of a volvulus Long mesentery Intestinal malrotation: abnormal rotation of the bowel with abnormal fixation of mesentery to the posterior abdominal wall Megacolon (Hirschsprung's disease, Chaga's disease [amboss.com]

To better understand the pathophysiology of Intestinal Malrotation, it is imperative to understand the anatomy of the abdomen, especially the position of the intestines, under normal circumstances. [epainassist.com]

[…] a short mesenteric attachment of small intestine in malrotation · Age o Usually neonate or young infant o Occasionally older child and adult · Associated with (in 20%) o Duodenal atresia o Duodenal diaphragm o Duodenal stenosis o Annular pancreas · Pathophysiology [learningradiology.com]

Pathophysiology GI malrotation, has been recently suggested to result from genetic mutations. The gene implicated is the fork head transcription factor (FOXF1) gene. [news-medical.net]

In other hands, many patients have co-morbidities, and consequently it is key to work with a low intra-abdominal pressure to prevent any conversion for pneumoperitoneum intolerance. [websurg.com]

There is no proven surgical strategy for preventing the recurrence of small bowel volvulus in case of malfixation of the midgut. [ncbi.nlm.nih.gov]

Children may be started on IV (intravenous) fluids to prevent dehydration and antibiotics to prevent infection. [chop.edu]