Acute diverticulitis in a patient with intestinal malrotation

Casajús, J.M. Peraza; Quiroga, I. Bodega; García-Oria, M.; Dawid, Natalia Z. Rosado; Desviat, P. Vallejo

doi:10.1590/S0104-42302012000400007

IMAGE IN MEDICINE

^IServicio de Cirugía General y del Aparato Digestivo. Hospital Central de la Defensa Gómez-Ulla, Madrid, Spain

^IIServicio de Aparato Digestivo, Hospital Central de la Defensa Gómez-Ulla, Madrid, Spain

^IIIServicio de Radiodiagnóstico, Hospital Central de la Defensa Gómez-Ulla, Madrid, Spain

Correspondence to

CLINICAL CASE

61 year-old female, afebrile and hemodynamically stable, admitted to emergency room reporting abdominal pain of 5 days duration. Abdominal examination: soft and depressible abdomen, painful on palpation at left iliac fossa, without defense. TAC: multiple diverticula in the descending colon and sigmoid, thickened wall and discrete pericolic fat inflammatory changes (Figure 1), ansae of the small intestine in right iliac fossa (RIF) (Figure 2), in maximum intensity projection (MIP), intersection of the superior mesenteric artery in front of the vein, at the right of it (Figure 3).

DISCUSSION

Intestinal malrotation in adults has an approximate incidence of 0.19%¹. It can have an acute presentation (intestinal obstruction, volvulus, intestinal ischemia) or a chronic one, with crampy abdominal pain and bilious vomiting. Sometimes patients are asymptomatic, being an incidental discovery to find it on radiological explorations due to other reasons, as in the case presented here. All symptomatic patients should be treated surgically, by the Prophylactic

Ladd Procedure. Our patient had no previous abdominal symptoms due to the intestinal malrotation. In asymptomatic adults this procedure is uncertain due to the low incidence of small intestine volvulus in these patients2,3.

REFERENCES

1. Lubinus Badillo FG, Rojas Rueda SP, Salcedo Hernández CJ. Intestinal malrotation as a cause for abdominal pain in adults. Case revision. Med UNAB. 2006;9:156-8.
2. Malek MM, Burd RS. Surgical treatment of malrotation after infancy: a population- based study. J Pediatr Surg. 2005;40:285-9.
3. Malek MM, Burd RS. The optimal management of malrotation diagnosed after infancy: a decision analysis. Am J Surg. 2006;191:45-51.