A rare case of untypical and unclassifiable malrotation Shinta NAGANO 1,2 , Yoshihiro KUBOTA 1 , Kazuya MIMURA 1 , Goshi MATSUKI 1 , Tomoko TAKAGISHI 1 , Takumi SHIMOMATSUYA 1 1Department of Surgery, Uji Tokushukai Medical Center 2Department of Pediatric Surgery, Kyoto Prefectural University of Medicine Keyword: 小児 , 腸回転異常症 , 特殊型 pp.358-365
Published Date 2021/9/15
DOI https://doi.org/10.11477/mf.4426200932
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 A 15-year-old boy was admitted to our hospital because of liver dysfunction, electrolyte abnormalities, and weight loss due to vomiting. After admission, bilious vomiting continued despite fasting, and he was referred to our department for suspected upper gastrointestinal obstruction. Computed tomography and an upper gastrointestinal series showed upper jejunal obstruction and the formation of ligament of Treitz and hepatic flexure. This indicated mechanical obstruction due to an internal hernia or band formation. Elective laparoscopic surgery was performed. The operative findings revealed an abnormally expanded duodenum and extremely extended jejunum; afferent and efferent limbs were found to have formed behind the mesentery with physiological adhesion. Laparoscopic division of the adhesions around the duodenum, jejunum, and limbs resolved the obstruction, and no bowel resection was required. At one year after surgery, no recurrence had occurred. The present case was probably caused by an embryological pathogenesis similar to that of right paraduodenal hernia.

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