Laparoscopic Ladd procedure for intestinal malrotation in an adult patient : A case report Noritoshi MIZUTA 1 , Yoshifumi FUKUDA 1 , Hidehiro SAWA 1 , Hirofumi KOSUGA 1 , Akihiro TOYOKAWA 1 1Department of Surgery, Akashi Medical Center Keyword: 腹腔鏡下手術 , 成人 , 腸回転異常症 pp.100-107
Published Date 2021/3/15
DOI https://doi.org/10.11477/mf.4426200883
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 Intestinal malrotation is a congenital disease caused by abnormal intestinal rotation and fixation during the early embryonic stage. Most onset occurs in the neonatal period, and rarely in adults. We report a case of laparoscopic Ladd procedure for intestinal malrotation in an adult patient. The patient, a 70-year-old male, underwent appendectomy for acute appendicitis at 14-years of age. One year prior to the current presentation, he had abdominal pain for the first time after a meal which continued thereafter. He visited our hospital for further examination. Abdominal CT showed absence of duodenal horizontal section ; the intestine instead transitioned directly from the descending section to the jejunum. The descending section and the jejunum were located in the right upper abdomen. Additionally, a superior mesenteric vein rotation sign was also observed in abdominal CT. The colon was located normally. Preoperative diagnosis was incomplete fixation type of intestinal malrotation. Laparoscopic Ladd procedure was performed to improve the symptoms. The hepatocolic ligament and the adhesion of the right colonic mesentery to retroperitoneum were cut. The stenosis of the small intestinal mesenteric root was dilated. The small intestine was returned to the right side, and the colon was positioned on the left side. The postoperative course was uneventful. In case of no intestinal dilation without necrosis, laparoscopic Ladd procedure is a safe and useful option for the intestinal malrotation in adults.

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