J Korean Surg Soc.  2010 Dec;79(Suppl 1):S37-S40. 10.4174/jkss.2010.79.Suppl1.S37.

Intestinal Malrotation with Concurrent Portal Vein and Superior Mesenteric Vein Thromboses

• Lee JS
• Lee IK
• Shim J
• Si Y
• Lee YS
• Oh ST

• KMID: 2040550
• DOI: http://doi.org/10.4174/jkss.2010.79.Suppl1.S37

Abstract

Intestinal malrotation with volvulus is generally presented as a bilious vomiting and acute intestinal obstruction in the newborn period. It could compromise vascular supply of the small bowel secondary to torsion of superior mesenteric artery (SMA) and without urgent surgical management, it could lead to detrimental outcomes such as transmural bowel infarction and sepsis. However, in chronic cases, it is rarely obstructs the vascular supply and propagates to an acute bowel infarction. Rarely, chronic malrotation with midgut volvulus may not reduce the mesenteric blood supply because of collateral vessels, and the chronically stagnated blood flow of the superior mesenteric vein (SMV) favors thrombus formation within the lumen. The recommended treatment is Ladd's procedure and anticoagulation therapy. The authors present an unusual case of intestinal malrotation with chronic volvulus resulting in superior mesenteric vein and portal vein thrombosis in a 28-year-old patient.

Keyword

Intestinal malrotation; Midgut volvulus; Portal thrombosis; Superior mesenteric vein thrombosis

MeSH Terms

Adult
Humans
Infant, Newborn
Infarction
Intestinal Obstruction
Intestinal Volvulus
Mesenteric Artery, Superior
Mesenteric Veins
Portal Vein
Sepsis
Thrombosis
Vomiting

Figure

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  Fig. 1 (A) Abdominopelvic CT shows the characteristic 'whirlpool' sign of jejunal loops. (B) Thrombosis is noted in superior mesenteric vein and portal vein. (C) Inhomogenous enhancement is also noted in arterial phase due to obstructive thrombosis in portal vein.

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  Fig. 2 Ladd's band is a congenital mesenteric band originating from ascending colon and extending over the duodenum to end in retroperitoneum.

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  Fig. 3 Ladd's procedure: Ladd’s band was divided and incidental appendectomy was performed. Small bowel is replaced entirely on the right side while the colon is positioned on the left.

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