Obscure duodenal malformation and other midgut malrotation defects in an elder with acute abdomen due to different prominent complicated pathology

Abstract

A 70-year old\xa0 man with severe comorbidities, hemodynamically stable, was emergently admitted for bowel obstruction. His chronic intractable constipation had never been \xa0evaluated.\xa0 The patient had\xa0 no history of abdominal\xa0 surgery.\xa0 Computed tomography indicated a large obstructive rectosigmoid tumour\xa0 and dolichocolon.\xa0\xa0 Immediate rectoscopy confirmed the presence of the obstructive tumour. Additionally, on emergent laparotomy, a malformed\xa0 right-sided \xa0duodenum with right-sided small bowel and other midgut malrotation defects, along with a small palpable lesion in the proximal descending colon, were also found. We performed a subtotal \xa0colectomy, mobilization of the only existing first and second duodenal portions,\xa0 division of mesenteric root adhesions, and \xa0a terminal ileostomy. The patient had a favourable outcome, was discharged on day 8. Histology revealed a pT3N1b rectosigmoid adenocarcinoma and an 1 cm in diameter localized \xa0c-kit+ stromal tumour in the proximal descending colon.\xa0 He received chemotherapy. The patient underwent a postoperative upper gastrointestinal contrast study which showed a well-functioning right-sided deranged duodenum. During a 36-months follow-up no recurrence of malignancy or of midgut malrotation defects has been recognized.