An Adult Case of Intestinal Malrotation Concomitant with Strangulated Intestinal Obstruction due to Internal Hernia

Shin Saida, Akiharu Yagawa, Daisuke Yamaguchi, Tomotaka Yasumura and Toshifusa Ozawa

Department of Surgery, Yamanashi Hospital of Social Insurance

We report a case of intestinal malrotation concomitant with strangulated intestinal obstruction due to a paraduodenal hernia. A 25-year-old man admitted for sudden severe right lateroabdominal pain onset and vomiting was found in CT to have aggregation of the mesenterium and small intestine enhanced poorly in the cul-de-sac at the right abdomen. The duodenum and jejunum took down the right side of the superior mesenteric artery, so emergency laparotomy was conducated for a strangulated intestinal obstruction due to a paraduodenal hernia. Intraoperative findings found no fixation of the retroperitoneum and mesenterium at the right side of the abdomen, and we visualized a hernia orifice about 3 cm in diameter and the jejunum attached about 40 cm from the edge of the hernia. Following herniotomy, the strangulated intestine didn't require resection because no sign of intestinal necrosis was seen. Adult malrotation rarely causes a strangulated internal obstruction.

Key words
intestinal malrotation, paraduodenal hernia, adult

Reprint requests
Shin Saida Department of Surgery, Yamanashi Hospital of Social Insurance
3-8-31 Asahi, Kofu, 400-0025 JAPAN

Accepted
November 19, 2008

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