In a remarkable showcase of medical expertise and precision, surgeons at Fukushima Red Cross Hospital successfully treated a 72-year-old woman suffering from a rare and complex condition known as intestinal malrotation accompanied by a right paraduodenal hernia. The details of this intricate case were meticulously chronicled in the latest issue of the Nihon Shokakibyo Gakkai Zasshi, The Japanese Journal of Gastro-enterology, published on January 26, 2024 (Vol. 121, Issue 1, pp. 42-48). The article is indexed under DOI: 10.11405/nisshoshi.121.42.
Case Report Overview
The patient had been experiencing a host of gastrointestinal symptoms, including nausea, vomiting, and diarrhea, along with liver dysfunction and hypokalemia, intermittently since 2013. Upon admission to the hospital in March 2020, a series of diagnostic procedures were conducted, including abdominal computed tomography (CT) scans and contrast-enhanced upper gastrointestinal imaging.
The imaging studies revealed a thickening of the descending duodenal wall and a sac-like appearance near the duodenal papilla, which is indicative of an abnormality. Notably absent was the duodenojejunal curvature, with two intestinal loops detected in the descending region. These findings are key hallmarks of intestinal malrotation, a condition where the intestines do not rotate and fix properly in the abdomen during fetal development.
Coupled with the malrotation was the existence of a right paraduodenal hernia, a rare congenital anomaly where a portion of the small intestine herniates into a sac located near the duodenum. This condition was categorized based on the Nishijima classification.
Surgical Approach
The decision to proceed with surgery was made after careful consideration of the patient’s persistent symptoms and the risks associated with the condition, including the potential for intestinal volvulus, which could lead to a life-threatening situation if left untreated. The surgical team, led by Dr. Rei Ohira and including Drs. Yukiko Kanno, Hiroyuki Asama, Kenta Kodama, and Masahito Kuroda, performed a meticulous surgery to correct both the malrotation and the hernia.
Postoperative Outcome
Postoperative recovery was a success. The patient’s gastrointestinal symptoms resolved, and significant improvements in liver function and potassium levels were observed. Recurrence of gastrointestinal issues was not reported, which speaks to the efficacy of the surgical intervention performed.
Implications for Future Care
This case stands out as a peculiar instance where a condition predominantly found in infants or children was diagnosed in an adult, a rarity that poses unique diagnostic and treatment challenges. The report illuminates the importance of comprehensive imaging and a high index of suspicion for atypical presentations of abdominal pain and gastrointestinal dysfunction.
The successful treatment has significant implications for the medical community. It underscores the possibility of encountering such rare occurrences in adult gastroenterological practice and the necessity for preparedness in managing them promptly and effectively.
References
1. Ohira, R., Kanno, Y., Asama, H., Kodama, K., & Kuroda, M. (2024). Intestinal Malrotation Accompanied by a Right Paraduodenal Hernia in an Adult: A Case Report. Nihon Shokakibyo Gakkai Zasshi, 121(1), 42-48. DOI: 10.11405/nisshoshi.121.42.
2. Torres, A. M., & Ziegler, M. M. (1993). Malrotation of the Intestine. World Journal of Surgery, 17(3), 326-331. DOI: 10.1007/BF01655132.
3. Emanuwa, O. F., Ayantunde, A. A., & Davies, T. W. (2011). Midgut Malrotation First Presenting as Acute Bowel Obstruction in Adulthood: A Case Report. World Journal of Emergency Surgery, 6, 22. DOI: 10.1186/1749-7922-6-22.
4. Pickhardt, P. J., & Bhalla, S. (2002). Intestinal Malrotation in Adolescents and Adults: Spectrum of Clinical and Imaging Features. AJR American Journal of Roentgenology, 179(6), 1429-1435. DOI: 10.2214/ajr.179.6.1791429.
5. Matzke, G. M., Dozois, E. J., Larson, D. W., & Moir, C. R. (2005). Surgical Management of Intestinal Malrotation in Adults: Comparative Results with Open and Laparoscopic Ladd Procedure. Surgical Endoscopy and Other Interventional Techniques, 19(11), 1416-1419. DOI: 10.1007/s00464-004-2272-x.
Keywords
1. Intestinal malrotation surgery
2. Right paraduodenal hernia
3. Adult gastrointestinal case report
4. Congenital intestinal disorders
5. Advanced diagnostic imaging gastroenterology
This insightful and detailed case report adds a new dimension to the understanding of intestinal malrotation and paraduodenal hernias in adults. It also serves as a testament to the evolving nature of surgical interventions in gastroenterology, adding valuable knowledge for the benefit of future patients confronted with similar conditions.