RESUMEN
Intestinal malrotation is primarily a surgical condition of neonates due to abnormal intestinal rotation during fetal development. Usually, the presentation is immediately after birth. Adult midgut malrotation is rare and primarily detected at laparotomy or incidental radiological imaging for various conditions. We report a sporadic case of a 35-year-old male who presented to the surgical outpatient department (OPD) complaining of dull aching abdominal pain after taking meals for two months. He was able to tolerate a liquid diet only and able to carry out his routine work comfortably. In imaging studies, it was found to be a case of midgut malrotation with volvulus and superior mesenteric artery (SMA) thrombosis with collaterals without features of intestinal obstruction. The patient underwent diagnostic laparoscopy, and a midgut volvulus was identified with Ladd's bands. He underwent exploratory laparotomy with Ladd's procedure. Postoperatively symptoms were resolved, and the patient was discharged in stable condition. If intestinal malrotation presents in adults, it is challenging to diagnose it as it presents with atypical symptoms like chronic vague abdominal pain and weight loss. Often radiological correlation is essential to diagnose such patients. For surgical intervention, a laparoscopic approach is considered better in expert hands. Even though the disease has a chronic course, a high index of suspicion should arise when treating such cases of intestinal malrotation in an adult male. Timely surgery can do miracles and prevent catastrophic complications.
RESUMEN
Established consensus suggests that enteral nutrition is more beneficial in patients with a functioning gut than parenteral nutrition. It helps in early physical rehabilitation from a disease or surgical stress and is associated with fewer complications compared to parenteral nutrition. Jejunal feeding is one of the routine modes of enteral nutrition in patients with gastric dysfunction, either due to surgery or critical illness. Various complications have been reported when using feeding tubes, grouped as mechanical, infectious, gastrointestinal, and metabolic. Here, we report an unusual case of a 47-year male with a history of prepyloric perforation repair leak who presented to us on postoperative day 14 with an enterocutaneous fistula and a feeding jejunostomy tube in situ. He was evaluated and managed conservatively and discharged on enteral feeds, both orally and via a jejunostomy tube. One month after discharge, he presented with features of intestinal obstruction with a missing jejunostomy tube. Radiological investigations suggested enteral migration of the jejunostomy tube, which was managed non-operatively, and the patient was discharged on day three post-admission after per rectal expulsion of the tube.
