Adult Intestinal Malrotation: When Things Turn the Wrong Way

Excerpt

A 26-year-old man presented to a local emergency department with hematemesis and melena associated with mild mid-epigastric abdominal discomfort and light-headedness. He had no prior history of gastrointestinal (GI) bleeding, but he recalled having as a young child, up to 10 years of age, intermittent self-limited attacks of crampy abdominal pain that were never severe enough to prompt evaluation. He had no other significant medical history. His past surgical history was notable only for skull surgery as an infant. He took no medications on a regular basis, and used non-steroidal anti-inflammatory drugs infrequently. From 18 to 21 years of age, he indulged in heavy alcohol use but currently had only 3–4 drinks per week. On presentation, his hemoglobin was 13.7 g/dl and his blood urea nitrogen 29 mg/dl; otherwise, his laboratory values were unremarkable. An esophagogastroduodenoscopy (EGD) to the second portion of the duodenum reportedly showed mild gastritis and no esophageal varices. He was sent home on a proton-pump inhibitor after he was observed 24 h without further GI bleeding. …