Mizuta Noritoshi, Kikuchi Takuya, Fukuda Yoshiyuki
Department of Surgery, Akashi Medical Center, AIJINKAI Health Care Corporation, Hyogo, Japan.
Case Rep Surg. 2022 Oct 18;2022:6874885. doi: 10.1155/2022/6874885. eCollection 2022.
Intestinal malrotation is a rare congenital disease caused by abnormal intestinal rotation and fixation of the intestinal tract in the early embryonic state. Adult cases are rare. A laparoscopic Ladd procedure for adult intestinal malrotation is increasingly reported, but owing to the rarity, some important aspects of the disease and its treatment may be overlooked. Three adult cases of intestinal malrotation that underwent surgery at our hospital between January 2019 and October 2020 were retrospectively examined about patient backgrounds, short-term results, and complications. All patients were male, median age was 54.6 years, and the complaints were abdominal pain and/or distention. No midgut volvulus was observed. The laparoscopic Ladd procedure was performed for all cases. One patient underwent reoperation (duodenoduodenostomy) because of impaired passage of the duodenal descending section due to postoperative pancreatic fistula. The postoperative courses of the other two patients were good. No recurrence of symptoms was observed in any of the cases. The reason for reoperation in one of the cases is considered to be pancreatic injury when the severe curve from the duodenum to the upper jejunum near the pancreatic head was straightened. Correction of the curve is important to improve passage disorder of the duodenum, but special care is required to avoid organ damage, especially during a laparoscopic procedure with forceps. The laparoscopic Ladd procedure for adult intestinal malrotation is recommended if there is no midgut volvulus; it is minimally invasive and a comparatively simple technique, but surgeons should take special care to avoid organ damage.
肠旋转不良是一种罕见的先天性疾病，由胚胎早期肠道旋转异常和肠道固定异常引起。成人病例罕见。越来越多的报道称对成人肠旋转不良采用腹腔镜Ladd手术，但由于该病罕见，其一些重要方面及其治疗可能被忽视。对2019年1月至2020年10月间在我院接受手术的3例成人肠旋转不良病例的患者背景、短期结果和并发症进行了回顾性研究。所有患者均为男性，中位年龄为54.6岁，主诉为腹痛和/或腹胀。未观察到中肠扭转。所有病例均行腹腔镜Ladd手术。1例患者因术后胰瘘导致十二指肠降部通过障碍而接受再次手术（十二指肠十二指肠吻合术）。其他2例患者术后病程良好。所有病例均未观察到症状复发。其中1例再次手术的原因被认为是在拉直胰头附近从十二指肠到空肠上段的严重弯曲时造成了胰腺损伤。矫正该弯曲对于改善十二指肠通过障碍很重要，但需要特别小心以避免器官损伤，尤其是在使用钳子的腹腔镜手术过程中。如果没有中肠扭转，推荐对成人肠旋转不良采用腹腔镜Ladd手术；该手术微创且技术相对简单，但外科医生应特别小心以避免器官损伤。
