Case Report

Laparoscopic gastric bypass in patients with unexpected intestinal malrotation: report of 2 cases and review of literature

Patrício Joana, Laranjeira Ânia, Machado Arnaldo, Silva Soraia, Carvalho Manuel, Amaro Margarida, Bento Manuel and Caravana Jorge
World Journal of Medical and Surgical Case Reports 2020, 9:1

Abstract

Background

Intestinal malrotation is a rare congenital abnormality that occurs as a result of an arrest of normal rotation and fixation of the embryonic gut. In adult age, it is extremely difficult to diagnose due to the non-specificity or lack of symptoms and is most commonly found intraoperatively.

Case Presentation

Two bariatric female patients were admitted for surgical treatment after multidisciplinary evaluation. Both of them underwent laparoscopic Roux-en-Y gastric bypass during which were found to have complete intestinal malrotation, unknown before surgery. None had experienced episodes of intestinal obstruction or other symptoms that suggested intestinal malrotation before. The postoperative period was uneventful and both were discharged on postoperative day 3, after an oesophagogastroduodenal transit that confirmed the diagnosis and excluded any other complication. The result in weight loss was identical to that of patients without anatomical abnormality.

Conclusions

aparoscopic Roux-en-Y gastric bypass is a bariatric treatment that can be successfully performed in patients with intestinal malrotation without the need of conversion to open operation, even if it is recognised only during surgical intervention. Nevertheless, before transecting the stomach or the intestine, the whole abdominal anatomy of the patient must be carefully explored to identify if modification of the surgical technique is necessary and feasible.

Keywords

Intestinal malrotation, gastric bypass, laparoscopy, obesity.

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