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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/08/28 15:27:04」(JST)

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Intestinal malrotation is a congenital anomaly of rotation of the midgut (embryologically, the gut undergoes a complex rotation outside the abdomen). As a result:

the small bowel is found predominantly on the right side of the abdomen
the cecum is displaced (from its usual position in the right lower quadrant) into the epigastrium - right hypochondrium
the ligament of Treitz is displaced inferiorly and rightward
fibrous bands (of Ladd) course over the horizontal part of the duodenum (DII), causing intestinal obstruction.
the small intestine has an unusually narrow base, and therefore the midgut is prone to volvulus (a twisting that can obstruct the mesenteric blood vessels and cause intestinal ischemia).

Associated conditions

This can lead to a number of disease manifestations such as:

Acute midgut volvulus
Chronic midgut volvulus
Acute duodenal obstruction
Chronic duodenal obstruction
Internal herniation
Superior mesenteric artery syndrome

Causes

The exact causes are not known. It is not associated with a particular gene, but there is some evidence of recurrence in families.^[1]

Presentation

Patients (often infants) present acutely with midgut volvulus, manifested by bilious vomiting, crampy abdominal pain, abdominal distention, and the passage of blood and mucus in their stool. Patients with chronic, uncorrected malrotation can have recurrent abdominal pain and vomiting.

Malrotation can also be entirely asymptomatic.

Diagnosis

With acutely ill patients, consider emergency surgery laparotomy if there is a high index of suspicion.

Plain radiography may demonstrate signs of duodenal obstruction with dilatation of the proximal duodenum and stomach but it is often non-specific. Upper gastrointestinal series is the modality of choice for the evaluation of malrotation as it will show an abnormal position of the duodeno-jejunal flexure (ligament of Treitz). In cases of malrotation complicated with volvulus, it demonstrates a corkscrew appearance of the distal duodenum and jejunum. In cases of obstructing Ladd bands, it will reveal a duodenal obstruction.

In equivocal cases, contrast enema, may be helpful by showing the caecum at an abnormal location.

It is usually discovered near birth, but in some cases is not discovered until adulthood.^[2] In adults, the "whirlpool sign" of the superior mesenteric artery can be useful in identifying malrotation.^[3]

Treatment

Treatment is possible and these are the steps taken: Resuscitate the patient with fluids to stabilize them before surgically

correcting the malrotation (counterclockwise rotation of the bowel)
cutting the fibrous bands over the duodenum.
widening the mesenteric pedicle by separation of the duodenum and cecum

With this condition the appendix is often on the wrong side of the body and therefore removed as a precautionary measure during the surgical procedure.

One surgical technique is known as "Ladd's procedure", after Dr. William Ladd.^[4]^[5]

Long term research on the Ladd procedure shows that even after the procedure, patients are susceptible to have complaints and might need further surgery. ^[6]

References

^ Stalker HJ, Chitayat D (1992). "Familial intestinal malrotation with midgut volvulus and facial anomalies: a disorder involving a gene controlling the normal gut rotation?". Am. J. Med. Genet. 44 (1): 46–7. doi:10.1002/ajmg.1320440111. PMID 1519649.
^ Dietz DW, Walsh RM, Grundfest-Broniatowski S, Lavery IC, Fazio VW, Vogt DP (2002). "Intestinal malrotation: a rare but important cause of bowel obstruction in adults". Dis. Colon Rectum 45 (10): 1381–6. doi:10.1007/s10350-004-6429-0. PMID 12394439.
^ Yeh WC, Wang HP, Chen C, Wang HH, Wu MS, Lin JT (1999). "Preoperative sonographic diagnosis of midgut malrotation with volvulus in adults: the "whirlpool" sign". Journal of Clinical Ultrasound 27 (5): 279–83. doi:10.1002/(SICI)1097-0096(199906)27:5<279::AID-JCU8>3.0.CO;2-G. PMID 10355892.
^ Ladd WE (1936). "Surgical Diseases of the Alimentary Tract in Infants". N Engl J Med 215: 705–8. doi:10.1056/NEJM193610152151604.
^ Bass KD, Rothenberg SS, Chang JH (1998). "Laparoscopic Ladd's procedure in infants with malrotation". J. Pediatr. Surg. 33 (2): 279–81. doi:10.1016/S0022-3468(98)90447-X. PMID 9498402.
^ Murphy FL, Sparnon AL (2006-04-01). "Long-term complications following intestinal malrotation and the Ladd’s procedure: a 15 year review". Pediatric Surgery International 22 (4): 326–329. doi:10.1007/s00383-006-1653-4.
^ Emanuwa et al. (2011). "Midgut malrotation first presenting as acute bowel obstruction in adulthood: a case report and literature review". World Journal of Emergency Surgery 6 (22). doi:10.1186/1749-7922-6-22.

External links

Macrorad Teleradiology Intestinal Malrotation of Adults

UpToDate Contents

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1. 腸回転異常 intestinal malrotation
2. 悪心および嘔吐を呈する幼児または小児に対するアプローチ approach to the infant or child with nausea and vomiting
3. 小児および思春期における急性腹症の原因 causes of acute abdominal pain in children and adolescents
4. 小児における下部消化管出血に対する診断アプローチ diagnostic approach to lower gastrointestinal bleeding in children
5. 幼児の肥厚性幽門狭窄症 infantile hypertrophic pyloric stenosis

English Journal

Biomechanical effects of total knee arthroplasty component malrotation: a computational simulation.

Thompson JA, Hast MW, Granger JF, Piazza SJ, Siston RA.SourceDepartment of Mechanical and Aerospace Engineering, The Ohio State University, E305 Scott Laboratory, 201W 19th Ave, Columbus, Ohio 43210-1142, USA.
Journal of orthopaedic research : official publication of the Orthopaedic Research Society.J Orthop Res.2011 Jul;29(7):969-75. doi: 10.1002/jor.21344. Epub 2011 Feb 24.
Modern total knee arthroplasty (TKA) is an effective procedure to treat pain and disability due to osteoarthritis, but some patients experience quadriceps weakness after surgery and have difficulty performing important activities of daily living. The success of TKA depends on many factors, but malal
PMID 21567450

Patient-oriented functional results of total femoral endoprosthetic reconstruction following oncologic resection.

Jones KB, Griffin AM, Chandrasekar CR, Biau D, Babinet A, Deheshi B, Bell RS, Grimer RJ, Wunder JS, Ferguson PC.SourceThe Department of Orthopaedics, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah. kevin.jones@hci.utah.edu.
Journal of surgical oncology.J Surg Oncol.2011 Jun 21. doi: 10.1002/jso.22003. [Epub ahead of print]
BACKGROUND AND OBJECTIVES: Functional outcomes following oncologic total femoral endoprosthetic reconstruction (TFR) are lacking. We compared patient-oriented functional results of TFRs to proximal femur and distal femur reconstructions (PFR and DFR). We also compared function and complications with
PMID 21695701

Japanese Journal

症例報告術前診断し得た左側傍十二指腸ヘルニアに対する腹腔鏡下手術の1例

小角卓也,米倉竹夫,山内勝治 [他]
日本小児外科学会雑誌 47(2), 256-260, 2011-04
NAID 40018816506

腸回転異常症が併存し十二指腸狭窄を合併した急性虫垂炎の1例

武藤満完,高橋道長,大沼勝,上野達也,内藤広郎
日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 71(6), 1550-1554, 2010-06-25
NAID 10026936781

Related Pictures

★リンクテーブル★

リンク元	「100Cases 60」

「100Cases 60」

Intestinal malrotation
	Classification and external resources
ICD-10	Q43.3
ICD-9	751.4
OMIM	193250
eMedicine	ped/1200

　　[★]

attend

vt.

～に出席/参列する、(学校に)行く(go toより堅い語)

The normal ECG and chest X-ray when he attended hospital after an episode do not rule out an intermittent conduction problem.

(結果として)～に伴う

～に同行/同伴する、付き添う、仕える。往診する。～の世話をする、～に気をつける、見張る

vi.

出席/参列/出勤する(at)

留意/注目/傾聴する(to)。身を入れる、勢力を注ぐ、心を傾注する(to)。世話をする、気を配る(to)

仕える、付きそう(on)。(危険・困難などが)伴う(on)

productive

adj

生産的な、生産力を有する(⇔unproductive
(擦過が)他作の。(土地などが)多産の、豊富に算出する
[叙述](～を)引き起こす、もたらす(of)
(事業などが)利益をもたらす、営利的な。良い結果をもたらす、実りの多い
(言語)(接辞などが)生産性のある
(医学)(咳が)喀痰を伴う。(炎症が)増殖性の

outflow

n.

流出/流出物。流出量

vi.

流出する

obstruction

n.

妨害、障害、支障、差し障り(to)。妨害物、

obstruction to outflow

the clinical picture suggests obstruction to outflow from the stomach.(この臨床像は胃流出障害を示唆している)

閉塞、閉塞症。

obstruction to outflow

流出障害

ex.

the clinical picture suggests obstruction to outflow from the stomach.(この臨床像は胃流出障害を示唆している)

aqueous outflow from the eye (眼球からの房水流出)

retain

re + tent (tineo=teneo) = to hold back

vt.

保持する、保有する、保留する、持ち続ける、維持する。(使用のために)確保しておく
(ある場所に)保つ、保持する。(熱などを)保っている、失わないでいる
忘れないでいる、覚えている
(弁護士・気腫・召使いなどを)雇っておく、抱える
使用/実行し続ける。(廃止しないで)そのままにしておく

palliation

n.

寛解、緩和

n.

強く揺り動かすこと、強く揺れること

splash

n.

はね返し、はねかけ。はねかす音。

どっと流れる水。

□unit

1 unit = 10 ml of ethanol

□350ml アルコール5%

350x0.05/10=1.75 unit

http://pohwa.adam.ne.jp/you/hobby/ryori/sake2.ht ml

1unitの量が国によって違う。純エタノール換算で、1英unitは8g=10ml（英糖尿病協会採用の数値）、1米unitは15g（20ml弱：1drinkとも）で、日本では10～14g程度（代謝熱量80Kcalが基準：食品成分表5訂版,2002）や20ないし23g（日本酒1合分）を1unitとしている。日本の医学界では1unit=20g（体積に換算すると25ml）を採用することが多いので、ここでもそれに従う。この基準（1unit=20g=25ml）で計算すると、40度のウィスキー1ショット（＝1オンス：英液量オンスで28.41ml、米液量オンスで29.57ml、日本の1ショットで30ml）が約0.5unitとなる。5度のビールなら500mlでだいたい1unit（この、日本酒1合≒ウィスキーダブル≒ビール500cc≒1unitという関係は、覚えておくと便利かもしれない：ワインなどは日本酒に準じるので、1本750mlがだいたい4unit強である）。

主訴：体重減少

(主訴にまつわる症状)

　・4ヶ月で10kg減少、食欲の減少、嘔吐(頻度：次第に増えてきている。嘔吐物と量：何時間も前に食べたものを多量に嘔吐する)

(主訴以外の症状)

　・一ヶ月前から脱力感(部位：特に下肢で著しい(丘に登ったり、階段を上ったりするとき))

嗜好歴：喫煙 20/day、飲酒 10units/week (ビール 6本弱)

家族歴：なし

既往歴：高血圧(2年間β遮断薬で治療、4ヶ月前に服薬中止)

身体所見 examination

バイタル：82/分、血圧 148/86 mmHg

全身：やせ、体調が悪そう(unwell)。

呼吸器、心血管系に異常なし