MALROTACION INTESTINAL PDF

Age-related differences in diagnosis and morbidity of intestinal malrotation. To report our experience using US to assess intestinal rotation. New to Read Sign Up. Successful treatment of a year-old patient with intestinal malrotation with laparoscopic Ladd procedure: We describe a method for delineating the duodenal anatomy with US as a means to exclude intesitnal.

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In the infant, the most common presentation is with a midgut volvulus. In the older child or even adult presentation is more frequently intermittent with episodes of spontaneously resolving duodenal obstruction. This is thought to be due to kinking of the duodenum by Ladd bands rather than a volvulus 5. Internal hernias are also encountered. In some individuals, the presentation is very non-specific with episodes of abdominal pain, weight loss, melena, or even chronic pancreatitis 5.

Pathology During normal embryogenesis, the bowel herniates into the base of the umbilical cord and rapidly elongates. This results in a broad mesentery running obliquely down from the DJ flexure to the cecum and prevents rotation around the superior mesenteric artery SMA In malrotation, this does not occur and, as a result, the mesentery often has a short root, which allows it to act as a pedicle through which the SMA and SMV pass around which volvulus can occur.

The rotation of the duodenojejunal loop has been described as beginning around the 5th gestational week and being complete around the 8th. Rotation of the cecocolic loop occurs at a later time, around the 10th week of gestational age.

This might explain forms of partial intestinal malrotation 9. The risk of volvulus is much lower in complete nonrotation because patients have the effective anatomy of those who have undergone a Ladd procedure. Radiographic features Plain radiograph Abdominal radiographs, in the absence of midgut volvulus , are neither specific nor sensitive 2.

A more useful sign on ultrasound is demonstrating the retro-mesenteric D3 segment of the duodenum, where the horizontal D3 segment of the duodenum is seen in a transverse plane between the superior mesenteric vessels and the aorta 8,10, Although demonstrating a retro-mesenteric duodenum is extremely sensitive and specific for excluding malrotation, it is not perfect and such a normal anatomic relationship has been described in at least one case of surgically treated intestinal malrotation with midgut volvulus 9.

This case was likely secondary to partial intestinal malrotation, based on the embryological delay described above between the rotation of the duodenojejunal loop and the cecocolic loop. The key findings of malrotation is an abnormal duodenojejunal DJ junction location: frontal view DJ junction fails to cross the midline to the left of the left-sided vertebral body pedicle DJ junction lies inferior to the duodenal bulb lateral view D2 and D3 segments of the duodenum not located posteriorly in a retroperitoneal position Although not a specific criteria of malrotation, the jejunum is commonly located to the left of the spine.

Contrast enema has historically also been used, the theory being that in malrotation the large bowel will also be malrotated. The converse is also true, with the position of the cecum in normal individuals being variable 4.

Very rarely, the cecum may be malrotated and the small bowel in a normal position. Treatment and prognosis Due to the potential for life-threatening midgut volvulus and ischemic bowel , once discovered malrotation is corrected surgically.

Hence, differential diagnoses must be kept in mind, including: normal duodenum: located inferiorly because of gastric distension or abnormally because of a feeding tube, renal agenesis, splenomegaly, etc.

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Intestinal malrotation

In the infant, the most common presentation is with a midgut volvulus. In the older child or even adult presentation is more frequently intermittent with episodes of spontaneously resolving duodenal obstruction. This is thought to be due to kinking of the duodenum by Ladd bands rather than a volvulus 5. Internal hernias are also encountered. In some individuals, the presentation is very non-specific with episodes of abdominal pain, weight loss, melena, or even chronic pancreatitis 5.

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Malrotación intestinal

Causes[ edit ] Diagram showing the process by which the intestine rotates and herniates during normal development. The small intestine forms loops B2 and slides back into the abdomen B3 during resolution of the hernia. It is not definitively associated with a particular gene, but there is some evidence of recurrence in families. In cases of volvulus, plain radiography may demonstrate signs of duodenal obstruction with dilatation of the proximal duodenum and stomach but it is often non-specific. Ultrasonography may be useful in some cases of volvulus, depicting a "whirlpool sign" where the superior mesenteric artery and Superior mesenteric vein have twisted.

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