Surgical approach in a patient with intestinal malrotation associated with adult hypertrophic pyloric stenosis

Abstract

Introduction. Intestinal malrotation and hypertrophic pyloric stenosis (HPS) are both rare diseases, usually diagnosed during infancy. In the medical literature there are only a few reports about infants who suffer from a combination of these diseases. The simultaneous occurrence of both diseases in adult patients is extremely rare. However, in this case, the surgical approach has to be a combination of different techniques, aiming at treating each one of the diseases separately. Case presentation. A 37-years-old female patient who presented for upper gastrointestinal symptoms was diagnosed with adult hypertrophic pyloric stenosis (AHPS), intestinal malrotation and consequent dilated stomach. The diagnosis was based on the history, clinical findings, imaging examinations (X-ray, abdominal computed tomography), and gastroscopy. The surgical approach included division of Ladd’s band and Jaboulay pyloroplasty. Conclusions. The simultaneous occurrence of intestinal malrotation associated with AHPS is an extremely rare condition. Applying a combined surgical approach may have good postoperative results.

Keywords

• intestinal malrotation
• adult pyloric stenosis
• dilated stomach
• ladd’s band
• jaboulay pyloroplasty