Laparoscopic Ladd Procedure for Intestinal Malrotation with Midgut Volvulus in an Adult

We report a case of laparoscopic Ladd procedure for intestinal malrotation with midgut volvulus in an adult. A 25-year-old man presented with the abrupt onset of severe abdominal pain and vomiting. Abdominal enhanced CT scan showed a whirl sign involving the engorged superior mesenteric vein (SMV) and soft tissue twisting around the superior mesenteric artery (SMA). We diagnosed the case as small bowel volvulus and performed emergency laparoscopic surgery. Laparoscopic findings showed that the bowel from the origin of jejunum to the ascending colon was twisted counter-clockwise by 540 degree around the SMA. After the laparoscopic reduction of the volvulus, the cecum and ascending colon were not fixed to the right retroperitoneum, the ligament of Treitz was not formed, and fibrous peritoneal bands (Ladd’s bands) were found. Midgut volvulus with intestinal malrotation was diagnosed, and we added Ladd procedure and prophylactic appendectomy. The operation was completed laparoscopically. The pa-tient had uneventful recovery, and is doing well as of 36 months after the surgery without having anoma-lies such as intestinal obstruction. Intestinal malrotation with midgut volvulus in adults is rare. Laparoscopic Ladd procedure for this setting is still controversial. This case suggests that laparoscopic Ladd procedure for intestinal malrotation with midgut volvulus is an effective treatment option that may reduce surgical stress, if intestinal ischemia or dilatation is absent and good vision under laparoscopy can be kept.