Acute midgut volvulus in a septuagenarian with secondary jejunoileal diverticulitis and undiagnosed congenital malrotation: an unusual presentation

A 79-year-old male presented with abdominal pain, incidental umbilical hernia and acute midgut volvulus that was not detected until surgical exploration. When he presented to hospital, computed tomography (CT) findings indicated perforated jejunoileal diverticulitis; however, in the operating room clockwise volvulization of the jejunum and ileum, secondarily inflamed jejunoileal diverticula, incomplete malrotation (right-sided duodenojejunal flexure), right retroperitoneal adhesions (Ladd’s bands) and numerous other congenital adhesive bands were found. A modified Ladd’s procedure and umbilical hernia repair were completed including detorsion, division of Ladd’s bands with medialization of the cecum and lysis of other congenital adhesions without appendectomy. The patient recovered to baseline function by 3 weeks postoperatively. Acute midgut volvulus is a life-threatening surgical emergency that is exceptionally rare in the elderly. CT is relatively insensitive, so misdiagnosis is common. A high index of suspicion is required, especially in patients with a history of congenital gastrointestinal abnormalities. Prompt surgical exploration for correction and prevention is crucial.

Laparoscopic Repair of a Right Paraduodenal Hernia

Laparoscopic repair of a right paraduodenal hernia has been described sparingly in literature. We present an account of how we laparoscopically repaired a right paraduodenal hernia along with a review of the current literature as regards the various techniques that have been attempted. With the patient in supine position, and with umbilical camera port and three 5 mm ports, we mobilized the cecum and ascending colon up to the third part of the duodenum, thereby widening the neck of the hernia sac in the Waldeyer fossa. This method is ideal for the less severe incomplete rotation presenting with right paraduodenal hernia where there are no Ladd's bands and there is no requirement for fetalization of the bowel.

Internal herniation of sigmoid colon into ladd's band

Ladd's bands are generally known to cause duodenal and small bowel obstruction. Sigmoid colon compression by Ladd's bands has not been reported till now though a few cases of colonic obstruction have been reported. We report a case of sigmoid colon obstruction secondary to its herniation into Ladd's band in a child with intestinal malrotation.DOI: http://dx.doi.org/10.3126/jcmsn.v7i3.6710 Journal of College of Medical Sciences-Nepal, 2011, Vol-7, No-3, 53-55