A Case Where Staged Celiotomy was Performed on Patient with Massive Intestinal Necrosis due to Intestinal Malrotation with Midgut Volvulus

Sasaki Hideaki, Yamashiro Toshimitu and Sunagawa Hiroki

Okinawa Prefectural Hokubu Hospital, Department of Surgery

We report a case of staged celiotomy in an elderly patient with massive intestinal necrosis due to nonrotation intestinal malrotation with midgut volvulus. The 83-year-old woman had been bedridden with brain infarction. After episodes of emesis since morning, she evidenced coffee-like emesis at night and was transferred to our department after going into shock. Celiotomy conducted under a diagnosis of intestinal volvulus with necrosis. After resection from an area of the small intestine obviously necrotic due to midgut volvulus clockwise to the right side of the transverse colon with an automatic suture device, we temporarily closed the abdomen, leaving the stump as is. The following day, when vital signs improved, we reopened the incision for Ladd's operation. Intestinal anastomosis was postponed due to severe inflammation of the small intestine. Two days later, we did another celiotomy to resect a 30cm, highly inflamed end of the small intestine, then conducted a side-to-side anastomosis on the remaining 130cm small intestine and transverse colon. Partial mucosal necrosis was observed in the resected small intestine. The postoperative course was uneventful. We suggest the need to be concerned about possible onsets of intestinal malrotation in the elderly and that staged celiotomy is a therapeutically useful option.

Key words
malrotation, staged celiotomy, jejunal diverticula

Reprint requests
Sasaki Hideaki Okinawa Prefectural Hokubu Hospital Department of Surgery 2-12-3 Oonaka, Nago 905-8512 JAPAN

Accepted
May 29, 2002

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