Variations of the technique used to manage intestinal malrotation have been introduced to prevent recurrent volvulus. These include re-establishment

of the normal gut anatomy by duodenopexy, caecopexy and suture fixation of the ascending colon to the right abdominal wall, in the retroperitoneal position [4, 5, 18]. We BIX 1294 in vitro offered a modified procedure to our patient by performing a division of Ladd’s bands and an appendicectomy. There was no volvulus and we did not feel that the duodenum needed to be mobilised and straightened in this case. Our patient has been completely symptom free during 12 months of follow up. There Hedgehog inhibitor are recent reports of the use of the laparoscopic approach in the surgical treatment of intestinal malrotation. The technique appears to be safe and effective when performed by experienced laparoscopic surgeons, especially in the absence of volvulus [2, 7, 8, 18, CX 5461 19]. Laparoscopic Ladd’s procedure in paediatric groups is increasingly reported in the literature. It is becoming more accepted as an initial approach to surgical correction of intestinal malrotation, resulting in shorter hospital stays. There are few reports of this approach in adults. The laparoscopic approach can be technically challenging and conversion to open procedure is common [2, 7, 8, 19]. A few published works have indicated that the laparoscopic approach can be successful in patients with

malrotation and midgut volvulus [8, 19]. A retrospective analysis of both open and laparoscopic Ladd’s procedures by Stanfill et al performed

at the Children’s Hospital of Illinois, USA noted that short-term results were superior with the laparoscopic approach and can be achieved without any increase in the duration of the operation [20]. Conclusions Intestinal malrotation is a rare condition but is considered an important cause of bowel obstruction in adults. The diagnosis of malrotation after childhood is difficult and usually not readily considered as the cause of intra-abdominal symptoms. The presentation is usually nonspecific and this often leads to diagnostic and treatment delay with possible bowel ischaemia and necrosis. Evidence of which portends a poor prognosis and death. Therefore, a high index of suspicion needs to be maintained and prompt surgical intervention Protein kinase N1 must be considered in order to prevent an abdominal catastrophe and fatality. There are no reliable means of identifying which group of patients with intestinal malrotation will develop subsequent complications. In the light of this, many authors are now advocating early surgical intervention in the form of a standard and modified Ladd’s procedure. There is evidence in the literature that the use of Ladd’s procedure or ordinary division of Ladd’s bands and adhesiolysis relieves symptoms and in fact, prevents recurrence in the majority of patients.