Congenital intestinal malrotation with gastric wall defects causing extensive gut necrosis and short gut syndrome:A case report

BACKGROUND Congenital intestinal malrotation(CIM)is a common malformation in neonates.Early diagnosis and surgical intervention can improve the prognosis.CIM combined with congenital gastric wall defect is a potentially fatal condition.We present a severe case of CIM with gastric wall defect causing extensive gut necrosis and short gut syndrome.After three operations,the neonate survived and subsequently showed normal growth and development during infancy.CASE SUMMARY A male neonate(age:4 d)was hospitalized due to bloody stools and vomiting for 2 d,and abdominal distention for 1 d.Emergent exploratory laparotomy revealed black purplish discoloration of the bowel loops.Bowel alignment was abnormal with congestion and dilatation of the entire intestine,and clockwise mesentery volvulus(720°).The posterior wall of the gastric body near the greater curvature showed a defect in the muscularis layer(approximately 5.5 cm),and a circular perforation(approximately 3 cm diameter)at the center of this defect.Ladd’s procedure was performed and gastric wall defect was repaired.Third operation performed 53 d after birth revealed extensive adherence of small intestine and peritoneum,and adhesion angulated between many small intestinal loops.We performed intestinal adhesiolysis,resection of necrotic intestine,and small bowel anastomosis.CONCLUSION This case highlights that prolonged medical treatment may help improve intestinal salvage after surgical removal of necrotic intestines,and improve patient prognosis.

Intestinal obstruction in pregnancy with reverse rotation of the midgut:A case report

BACKGROUND Reverse rotation of the midgut is a rare type of intestinal malrotation.Volvulus of the right colon or entire midgut,stenosis of the transverse colon and obstruction of the duodenojejunal junction are common complications of reverse rotation.In this study,we report the first case of intestinal obstruction associated with reverse rotation in pregnancy.CASE SUMMARY A 31-year-old woman at 362+wk gestation presented to the emergency department with progressive abdominal cramping,nausea and bilious vomiting.Abdominal ultrasound scanning showed dilatation of the bowel.Computed tomography scanning revealed features of reverse rotation of the midgut with intestinal volvulus.After consultation with the obstetrician,the pregnancy was terminated and exploratory abdominal surgery was performed.Intra-operatively,it was found that the mesentery of the colon and small intestine was insufficiently attached.The right colon and the small intestinal mesentery was twisted,and intestinal necrosis was observed.The duodenum and duodenojejunal junction were curved in front of the transverse colon,and the transverse colon passed through the tunnel behind the mesenteric root.Intestinal reverse rotation with volvulus was confirmed.The necrotic intestine was resected and small intestine mesenteric reconstruction was performed.The patient recovered after surgery.After leaving the hospital,the patient and her daughter remained well during an 8-month follow-up period.CONCLUSION We report the diagnosis,treatment and etiology of a pregnant patient with intestinal obstruction due to reverse rotation of the midgut.For similar cases,appropriate diagnosis and treatment should be carried out according to the condition of the fetus and pregnant woman.