Congenital Malrotation of Midgut – A Case Report 先天性中腸扭轉案例報告 浦大維 李家政 陳昭仰 吳昌杰 饒樹文 國防醫學院三軍總醫院外科部 大腸直腸外科 1 1
Case profile Name：陳X X Gender / Age : Male / 52 Y Chief complaint: Frequent left side lower abdominal pain for several months Past history: no particular abnormal findings
Present illness CC：Frequent left side lower abdominal pain for several months Colonoscopy: Incomplete due to pain (only advanced to 40cm away from anal verge) Barium enema: Malposition of right side colon with fixed cecum over middle lower abdomen Previous CT of abdomen (2 years ago performed due to abdominal pain): identical findings with barium enema 病人因數月之左下腹反覆疼痛至門診求診，大腸鏡檢查由於疼痛無法完成 後續安排大腸鋇劑攝影發現病患中腸扭轉。 追蹤個案發現病患二年前因腹痛就診有做腹部電腦斷層檢查
KUB and Barium enema Barium enema showed malposition of colon with cecum fixed over lower midline position Barium enema showed malposition of colon with cecum fixed over lower midline position
CT of abdomen and pelvis Malposition of colon over left side abdomen and small bowel over right side Malposition of colon over left side abdomen and small bowel over right side
Midgut Malrotation Definition: any deviation from the normal 270o counterclockwise rotation of the midgut during embryologic development Incidence: unclear Often presents within the first month of life Usually difficult to recognizing this unsuspected diagnosis in adult age
Midgut Malrotation 左圖為正常發胚胎發育中常逆時針旋轉270度，腸係膜機底部較寬（點狀線）不易發生中腸扭結（midgut volvulus) 右圖則為發生中常先天性扭轉時,腸繫膜基底部教窄，易發生中常扭結 左圖為正常發胚胎發育中腸逆時針旋轉270度，腸係膜基底部較寬（點狀線）不易發生中腸扭結（midgut volvulus) 右圖則為發生中腸先天性扭轉時,腸繫膜基底部較窄，易發生中腸扭結
Midgut Malrotation Two most serious complications in adult: Midgut volvulus Internal herniation Some literature suggest surgery for malrotation regardless of age Though rarely occurred in adult age, the diagnosis should considered because it might lead patient to serious life-threatening complications
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