Ladd's band in the adult, an unusual case of occlusion: Case report and review of the literature. (2020)

• Record Type: Journal Article
• Authors: Grassi, Carmine; Conti, Luigi; Palmieri, Gerardo; Banchini, Filippo; Dacco', Maria Diletta; Cattaneo, Gaetano Maria; Capelli, Patrizio
• Is Part Of: International journal of surgery case reports. Volume 71(2020)
• Page Start: 45
• Page End: 49
• Publication Date: 2020
• Subjects: Gut malrotation -- Ladd's band -- Bowel obstruction; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2020.04.046
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Malrotation of gut is a congenital anomaly of foetal intestinal rotation and is very rare and often silent in adults. We performed a laparotomic Ladd's procedure in a case of 44 year old woman with acute abdominal pain. Intestinal malrotation is a rare entity and adult presentation is even rarer. Some cases are asymptomatic, but when symptomatic a volvulus should be promptly suspected to avoid complications such as bowel ischemia. Abstract: Introduction: Malrotation of gut is a congenital anomaly of foetal intestinal rotation and it is mostly discovered in early childhood as acute intestinal obstruction. This condition is very rare and often silent in adults. Presentation of case: We present a case of 44-year-old woman admitted with acute abdominal pain. The abdominal CT scan showed ileal conglomerate loops with thickened walls filled of liquid in the right iliac side. Laparotomic Ladd's procedure was performed successfully with division of Ladd's band, adhesiolysis, reconstruction of Treitz's ligament, small bowel resection and Merckel's diverticulum removal. The patient made an unremarkable recovery. Discussion: We discuss the rarity of intestinal malrotation in adulthood and made a literature review comparison of the therapeutic options available. Conclusion: Intestinal malrotation is a rare entity and adult presentation is even rarer. Some cases are asymptomatic, but when symptomatic a volvulus should be promptly suspected to avoid complications such as bowel ischemia.