PDF(Pubmed)
Abstract：
BACKGROUND: Reverse midgut rotation constituted an extremely rare intestinal malrotation. Its recognition in the elderly was challenging as in our case revealed by cecal volvulus.
METHODS: A 78-years old man consulted for diffuse abdominal, vomiting, bowel movement and passing gas inability. Computed tomography concluded to cecal and last ileum loop volvulus with small intestine dilation upstream. Emergent laparotomy confirmed the existence of a cecal volvulus associated to a reversed midgut rotation non diagnosed at computed tomography before surgery. A Ladd\' procedure was carried out. An isoperistaltic side-by-side ileocolic manual anastomosis was performed.
CONCLUSIONS: Our case illustrated an extremely rare reversed midgut rotation in the elderly accounting for 2 to 7 % of all embryologic midgut malrotation anomalies. It could be revealed by mobile right colon volvulus as in our case, whole midgut volvulus, retro-arterial tunnel pressure transverse colon stenosis, or Ladd\' bands duodenojejunal obstruction. Its recognition at the elderly was challenging and needed careful computed tomography combined signs determination. Surgical treatment accounted for the treatment of choice for reversed midgut rotation especially in emergency settings as in our case. Ladd\' procedure is still the most performed procedure.
CONCLUSIONS: Reverse midgut rotation constituted an extremely rare congenital intestinal malrotation. Its diagnosis in the elderly was challenging implicating careful interpretation of computed tomography.
METHODS: A 78-years old man consulted for diffuse abdominal, vomiting, bowel movement and passing gas inability. Computed tomography concluded to cecal and last ileum loop volvulus with small intestine dilation upstream. Emergent laparotomy confirmed the existence of a cecal volvulus associated to a reversed midgut rotation non diagnosed at computed tomography before surgery. A Ladd\' procedure was carried out. An isoperistaltic side-by-side ileocolic manual anastomosis was performed.
CONCLUSIONS: Our case illustrated an extremely rare reversed midgut rotation in the elderly accounting for 2 to 7 % of all embryologic midgut malrotation anomalies. It could be revealed by mobile right colon volvulus as in our case, whole midgut volvulus, retro-arterial tunnel pressure transverse colon stenosis, or Ladd\' bands duodenojejunal obstruction. Its recognition at the elderly was challenging and needed careful computed tomography combined signs determination. Surgical treatment accounted for the treatment of choice for reversed midgut rotation especially in emergency settings as in our case. Ladd\' procedure is still the most performed procedure.
CONCLUSIONS: Reverse midgut rotation constituted an extremely rare congenital intestinal malrotation. Its diagnosis in the elderly was challenging implicating careful interpretation of computed tomography.
摘要：
背景：中肠反向旋转是一种极为罕见的肠旋转不良。它在老年人中的识别具有挑战性，就像我们的盲肠扭转所揭示的那样。
方法：一名78岁男子因腹部弥漫性咨询，呕吐,排便和通过气体无法。计算机断层扫描得出的结论是盲肠和最后一个回肠loop扭转，上游小肠扩张。紧急剖腹手术证实存在与手术前计算机断层扫描未诊断的中肠旋转逆转相关的盲肠扭转。执行了Ladd\'程序。进行了等周并排回肠手动吻合术。
结论：我们的病例表明，老年人中肠旋转逆转极为罕见，占所有胚胎性中肠旋转不良异常的2％至7％。就像我们的例子一样，它可以通过移动右结肠扭转来揭示，整个中肠扭转,动脉后隧道压力横结肠狭窄，或Ladd带十二指肠空肠梗阻。它在老年人中的识别具有挑战性，需要仔细的计算机断层扫描结合体征确定。手术治疗是中肠旋转逆转的首选治疗方法，尤其是在我们的紧急情况下。Ladd\'过程仍然是执行次数最多的过程。
结论：中肠反向旋转是一种极为罕见的先天性肠旋转不良。它在老年人中的诊断具有挑战性，涉及对计算机断层扫描的仔细解释。
方法：一名78岁男子因腹部弥漫性咨询，呕吐,排便和通过气体无法。计算机断层扫描得出的结论是盲肠和最后一个回肠loop扭转，上游小肠扩张。紧急剖腹手术证实存在与手术前计算机断层扫描未诊断的中肠旋转逆转相关的盲肠扭转。执行了Ladd\'程序。进行了等周并排回肠手动吻合术。
结论：我们的病例表明，老年人中肠旋转逆转极为罕见，占所有胚胎性中肠旋转不良异常的2％至7％。就像我们的例子一样，它可以通过移动右结肠扭转来揭示，整个中肠扭转,动脉后隧道压力横结肠狭窄，或Ladd带十二指肠空肠梗阻。它在老年人中的识别具有挑战性，需要仔细的计算机断层扫描结合体征确定。手术治疗是中肠旋转逆转的首选治疗方法，尤其是在我们的紧急情况下。Ladd\'过程仍然是执行次数最多的过程。
结论：中肠反向旋转是一种极为罕见的先天性肠旋转不良。它在老年人中的诊断具有挑战性，涉及对计算机断层扫描的仔细解释。
