Ann Chir 2006,131(1):48–50. Epub 2005 Aug 15PubMedCrossRef Competing interests The authors

declare that they have no competing interests. Authors’ contributions SP drafted the manuscript. SDC made substantial SBI-0206965 mouse revisions. Both authors have revised, read and approved the article.”
“Introduction Midgut malrotation is a congenital anomaly in the embryological development of the foetal intestinal rotation. It has been estimated that it affects approximately 1 in 500 live births [1]. However, the true incidence is difficult to determine as a substantial number of cases will go undetected throughout life. The vast majority of the complications associated with midgut malrotation present in the first month of life and 60-85% of cases are diagnosed in this age group [1, 2]. It is reported that more than 90% of patients will present by the time of their first birthday [3]. Adult midgut malrotation is very rare and its incidence has been reported to be between 0.0001% and 0.19% [3, 4]. Most adult diagnoses of midgut malrotation are made in asymptomatic patients; either on imaging investigations for unrelated conditions or at operations for other pathology. This scenario of incidental diagnosis is becoming increasingly

common, particularly with improvements, and Belnacasan chemical structure increased use, of diagnostic imaging techniques in modern practice. However, there are a small proportion of affected adults who may present with acute or chronic symptoms www.selleckchem.com/products/NVP-AUY922.html of intestinal obstruction or intermittent and recurrent abdominal pain. The true diagnosis in this age group is fraught with immense difficulty, especially because the typical presentation is with non-specific symptoms and the fact that

adult Surgeons usually have low index of suspicion and may not consider the diagnosis a possibility in the initial evaluation of adult patients with abdominal pain. We report a case of an adult patient with an acute presentation of midgut malrotation which highlights the dilemmas of preoperative diagnosis, as supported by a Carteolol HCl review of the literature. Case report A 55-year old gentleman was admitted to the Accident and Emergency department with a three day history of acute onset, cramp like abdominal pain. There was associated nausea but no vomiting. Bowels had been opened the day before admission but no flatus had been passed for 24 hours. There were no other associated red flag symptoms. The patient had never experienced similar symptoms and had no previous medical or surgical history. On examination, the patient was afebrile and haemodynamically stable. The abdomen was moderately distended with significant tenderness in the central, epigastric and left hypochondrial regions. There was no evidence of peritonitis. Routine admission blood tests including serum electrolytes, urea, amylase, lactate, liver function tests (LFTs), clotting profile, C-reactive protein (CRP) and an arterial blood gas (ABG) were normal. However, a full blood count (FBC) demonstrated a haemoglobin level of 14.