Midgut volvulus with cavernous transformation of the portal vein in a middle-aged patient: a case report

Obada Al-leimon; Abdallah Hamdan; Ahmad Al-leimon; Mohammad Rashdan

doi:10.58877/japaj.v2i2.166

Authors

Obada Al-leimon School of Medicine -The University of Jordan, Amman, 11942 Jordan https://orcid.org/0000-0001-5320-1170
Abdallah Hamdan Department of General Surgery, Jordan University Hospital, Amman 11942, Jordan
Ahmad Al-leimon School of Medicine -The University of Jordan, Amman, 11942 Jordan
Mohammad Rashdan Department of General Surgery, Jordan University Hospital, Amman 11942, Jordan

DOI:

https://doi.org/10.58877/japaj.v2i2.166

Keywords:

midgut volvulus, midgut malrotation, cavernous transformation of the portal vein, Intestinal obstruction, Case report

Abstract

Introduction: midgut volvulus and cavernous transformation of the portal vein (CTPV) are rare conditions in adults. congenital anomaly of the intestines that can cause midgut volvulus, a life-threatening intestinal obstruction, in adults with nonspecific symptoms and diagnostic challenges. Case Presentation: We report a case of A 46-year-old male who had severe central abdominal pain, vomiting, and obstipation for three days, indicating intestinal obstruction. The CT without contrast revealed midgut malrotation with small bowel obstruction due to volvulus. The post-operative CT with contrast findings reveals the presence of multiple collaterals of the portal vein, which is suggestive of cavernous transformation. The procedure: During the procedure, intraoperative findings revealed a Ladd band, the DJ junction in the right upper quadrant, and a gangrenous bowel segment measuring approximately 30 centimeters in length and located 50 centimeters distal to the DJ junction. The surgical approach included a Ladd's procedure, lysis of the band, resection of the gangrenous section, with a side-to-side anastomosis, and an appendectomy. Conclusion: A unique case study presents an adult with two uncommon conditions—midgut volvulus and cavernous transformation of the portal vein. Their occurrence is rarely seen in adults, requires a multidisciplinary approach for diagnosis and management, emphasizing early detection and intervention to prevent severe complications. This case report contributes novel insights to these conditions and underscores the need for swift action, potentially marking the first instance documented in medical literature

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