Abstract：
Intestinal malrotation (IM) is an abnormality due to a failure of the normal midgut rotation and fixation. We report a case of 46-year-old man with ulcerative colitis whose IM was apparent after laparoscopically total proctocolectomy (TPC) followed by ileal-pouch-anal anastomosis (IPAA) and ileostomy. There was no abnormal anatomy except for mobile cecum/ascending colon during the initial operation. Intestinal obstruction occurred after ileostomy closure. The computed tomography scan showed the duodeno-jejunal transition was located in right abdomen, the superior mesenteric vein was located left of the superior mesenteric artery (SMA) and the obstruction point was the distal ileum near the pouch. We performed an ileo-ileo bypass across the ventral side of the SMA to relieve the intestinal obstruction. The patient would have incomplete IM preoperatively, which became apparent by TPC. In case of TPC for mobile colon, anatomy of small intestine should be checked before IPAA.
摘要：
肠旋转不良（IM）是由于正常中肠旋转和固定失败而引起的异常。我们报告了一例46岁的溃疡性结肠炎患者，其IM在腹腔镜全结直肠切除术（TPC），然后进行回肠-袋-肛门吻合术（IPAA）和回肠造口术后明显。在最初的手术中，除了移动的盲肠/升结肠外，没有异常的解剖结构。回肠造口术闭合后发生肠梗阻。计算机断层扫描显示十二指肠空肠过渡位于右腹部，肠系膜上静脉位于肠系膜上动脉（SMA）的左侧，阻塞点位于袋附近的远端回肠。我们在SMA的腹侧进行了回肠-回肠旁路术，以缓解肠梗阻。患者术前会有不完整的IM，这在TPC中变得明显。在移动结肠的TPC的情况下，在IPAA之前应检查小肠的解剖结构。
