Non-rotation of the Intestine: A Rare and Unexpected Cause of Bowel Obstruction in an Octogenarian

Area of Science:

• Gastroenterology
• Surgical Innovation
• Abdominal Surgery

Background:

• Small bowel obstruction is a common surgical emergency.
• Intestinal malrotation can lead to midgut volvulus and obstruction, even in adulthood.
• Ladd's bands are congenital adhesions associated with malrotation that can cause obstruction.

Observation:

• An 85-year-old male presented with symptoms of low-grade small bowel obstruction.
• CT scan suggested obstruction; however, diagnostic laparoscopy revealed malrotation and Ladd's bands.
• The patient experienced elevated lactate and deteriorating renal function, necessitating surgical intervention.

Findings:

• Laparoscopic findings indicated malrotation, prompting an open laparotomy.
• The surgery confirmed Ladd's bands causing small bowel torsion.
• Ladd's bands were lysed, the bowel detorsed and repositioned, and the mesentery widened.

Implications:

• Surgical correction of malrotation and Ladd's bands can effectively treat adult-onset small bowel obstruction.
• Prompt diagnosis and surgical intervention are crucial for favorable outcomes.
• This case highlights the importance of considering malrotation in elderly patients presenting with obstructive symptoms.