Malrotation of gut presenting in adolescents and adults at a tertiary care hospital: a prospective study

Abstract

Background: Although malrotation of gut presenting in adolescents and adults is rare, but exists. Also its presentation is nonspecific.  Hence its diagnosis needs high index of suspicion.Methods: This prospective study was done in the department of surgery at SMHS hospital (GMC Srinagar) over a period of 5.5 years from July 2012 to December 2017. The patients included all  the adolescent and adult patients who proved  to be the cases of malrotation of gut on intraoperative  visualisation.Results: During the study period, 14 patients with malrotation of gut (belonging to adolescent and adult age group) were recorded. Age of the patients ranged from 16 to 54 years with an average of 26.21±11.15years. Majority of the patients belonged to adolescent age group. Preoperatively CT (computed tomography) scan was done only in 4 patients, thereby making the diagnosis of malrotation preoperatively in these 4 patients. In all other patients, the diagnosis was made only after laparotomy (for acute abdomen) and intraoperative visualisation. Ladd´s procedure was done successfully in majority of patients with two patients requiring resection of gangrenous small bowl and stoma formation.Conclusions: Malrotation of gut presenting in adolescents and adults is a rare phenomenon and also the symptoms are similar to several other abdominal pathologies, hence it represents a diagnostic challenge. Hence a high index of suspicion is needed to diagnose this rare entity early without undue delay. Threshold for CT scan should be kept a little low in suspicious cases so as to diagnose and intervene in time.