{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T21:35:33Z","timestamp":1788989733569,"version":"build-2803163510"},"reference-count":59,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,2,6]],"date-time":"2020-02-06T00:00:00Z","timestamp":1580947200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,2,6]],"date-time":"2020-02-06T00:00:00Z","timestamp":1580947200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2020,2,6]],"date-time":"2020-02-06T00:00:00Z","timestamp":1580947200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Adult midgut malrotation is a rare cause of an acute abdomen requiring urgent intervention. It may also present in the non\u2010acute setting with chronic, non\u2010specific symptoms. The objective of this study is to identify the clinical features, appropriate investigations and current surgical management associated with adult malrotation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic review was conducted according to PRISMA guidelines, identifying confirmed cases of adult malrotation. Patient demographics, clinical features, investigation findings and operative details were analysed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty\u2010five reports met the inclusion criteria, totalling 194 cases. Mean age was 38.9 years (<jats:italic>n<\/jats:italic>\u2009=\u200992), and 52.3% were male (<jats:italic>n<\/jats:italic>\u2009=\u2009130). The commonest presenting complaints were abdominal pain (76.8%), vomiting (35.1%) and food intolerance (21.6%). At least one chronic symptom was reported in 87.6% and included intermittent abdominal pain (41.2%), vomiting (12.4%) and obstipation (11.9%). Computerised tomography scanning was the most frequent imaging modality (81.4%), with a sensitivity of 97.5%. The whirlpool sign was observed in 30.9%; abnormalities of the superior mesenteric axis were the commonest finding (58.0%). Ladd's procedure was the most common surgical intervention (74.5%). There was no significant difference in resolution rates between emergency and elective procedures (<jats:italic>p<\/jats:italic>\u2009=\u20090.46), but length of stay was significantly shorter for elective cases. (<jats:italic>p<\/jats:italic>\u2009=\u20090.009). There was no significant difference in risk of mortality, or symptom resolution, between operative and conservative management (<jats:italic>p<\/jats:italic>\u2009=\u20090.14 and <jats:italic>p<\/jats:italic>\u2009=\u20090.44, respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Malrotation in the adult manifests with chronic symptoms and should be considered as a differential diagnosis in patients with abdominal pain, vomiting and food intolerance.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-020-05403-7","type":"journal-article","created":{"date-parts":[[2020,2,6]],"date-time":"2020-02-06T18:05:41Z","timestamp":1581012341000},"page":"1771-1778","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":57,"title":["Adult Presentations of Congenital Midgut Malrotation: A Systematic Review"],"prefix":"10.1002","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4049-3896","authenticated-orcid":false,"given":"Jonathan J.","family":"Neville","sequence":"first","affiliation":[{"name":"Ealing Hospital, London North West University Healthcare NHS Trust Uxbridge Road UB1 3HW London UK"},{"name":"Imperial College Healthcare NHS Trust W2 1NY Paddington, London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Gallagher","sequence":"additional","affiliation":[{"name":"Ealing Hospital, London North West University Healthcare NHS Trust Uxbridge Road UB1 3HW London UK"},{"name":"Imperial College Healthcare NHS Trust W2 1NY Paddington, London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anuja","family":"Mitra","sequence":"additional","affiliation":[{"name":"Ealing Hospital, London North West University Healthcare NHS Trust Uxbridge Road UB1 3HW London UK"},{"name":"Imperial College Healthcare NHS Trust W2 1NY Paddington, London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hemant","family":"Sheth","sequence":"additional","affiliation":[{"name":"Ealing Hospital, London North West University Healthcare NHS Trust Uxbridge Road UB1 3HW London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,2,6]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12861\u2010015\u20100081\u2010x"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijscr.2014.02.013"},{"key":"e_1_2_8_4_1","doi-asserted-by":"crossref","unstructured":"LowSF NgiuCS SridharanR LeeYLMidgut malrotation with congenital peritoneal band: a rare cause of small bowel obstruction in adulthood.BMJ Case Rep(2014)10.1136\/bcr\u20102013\u2010202690247291143987558","DOI":"10.1136\/bcr-2013-202690"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0149\u20107944(03)00030\u20108"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajg.2015.03.002"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2007.08.035"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/1749\u20107922\u20106\u201022"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2014.12.048"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12664\u2010018\u20100914\u20101"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2010.07.004"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2007.11.020"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12664\u2010017\u20100729\u20105"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2005.12.070"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000008287"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.7863\/jum.2004.23.3.397"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.3348\/kjr.2008.9.5.466"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1308\/003588412X13373405384819"},{"key":"e_1_2_8_19_1","first-page":"4719","article-title":"Recurrent acute pancreatitis in bowel malrotation","volume":"20","author":"Alessandri G","year":"2016","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00383\u2010005\u20101466\u2010x"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijscr.2015.06.013"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464\u2010004\u20108249\u20107"},{"key":"e_1_2_8_23_1","first-page":"337","article-title":"Incidental intestinal malrotation in an adult: Midgut volvulus","volume":"34","author":"Kafadar MT","year":"2018","journal-title":"Turk J Surg"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.12659\/AJCR.913039"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13256\u2010018\u20101802\u20100"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijscr.2018.07.007"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2018.29.154.13910"},{"key":"e_1_2_8_28_1","doi-asserted-by":"crossref","unstructured":"MehrkhuM Shirvani DehkordiI Shirvani DehkordiP Shirvani DehkordiAPneumatosis intestinalis in an adult patient with antral stenosis and midgut malrotation.BMJ Case Rep(2018)10.1136\/bcr\u20102017\u2010223238300302426058115","DOI":"10.1136\/bcr-2017-223238"},{"key":"e_1_2_8_29_1","doi-asserted-by":"crossref","unstructured":"OngM RobertsM PereraM PretoriusC(2017) Case of a strangulated right paraduodenal fossa hernia in a malrotated gut.BMJ Case Rep","DOI":"10.1136\/bcr-2017-220645"},{"key":"e_1_2_8_30_1","first-page":"rjx081","article-title":"Malrotation with midgut volvulus in an adult: a case report and review of the literature","volume":"5","author":"Fung AT","year":"2017","journal-title":"J Surg Case Rep"},{"key":"e_1_2_8_31_1","first-page":"1079192","article-title":"Utility of the CT scan in diagnosing midgut volvulus in patients with chronic abdominal pain","volume":"2017","author":"Shahverdi E","year":"2017","journal-title":"Case Rep Surg"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinimag.2017.01.002"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jviscsurg.2016.06.010"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40792\u2010016\u20100205\u2010y"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2016.05.025"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40064\u2010016\u20101842\u20100"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijscr.2016.03.018"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2016.7.31011"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.5812\/iranjradiol.17853v2"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12664\u2010015\u20100596\u2010x"},{"key":"e_1_2_8_41_1","doi-asserted-by":"crossref","unstructured":"ChumberS PolMM AkhtarJ UniyalMMalrotation of the gut harbouring midgut volvulus in an adult with situs inversus totalis: a clinical delay and treatment dilemma.BMJ Case Rep(2015)10.1136\/bcr\u20102015\u2010211205263110114550880","DOI":"10.1136\/bcr-2015-211205"},{"key":"e_1_2_8_42_1","doi-asserted-by":"crossref","unstructured":"GemmellAPartial malrotation of the bowel in an adult patient presenting with abdominal pain.BMJ Case Rep(2015)10.1136\/bcr\u20102015\u2010211591262943614551017","DOI":"10.1136\/bcr-2015-211591"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijscr.2014.11.063"},{"key":"e_1_2_8_44_1","first-page":"1614","article-title":"Adult congenital intestinal malrotation accompanied by midgut volvulus: report of eight cases","volume":"7","author":"Zheng Z\u2010H","year":"2014","journal-title":"Int J Clin Exp Med"},{"key":"e_1_2_8_45_1","first-page":"758032","article-title":"Midgut malrotation causing intermittent intestinal obstruction in a young adult","volume":"2014","author":"Bektasoglu HK","year":"2014","journal-title":"Case Rep Surg"},{"key":"e_1_2_8_46_1","doi-asserted-by":"crossref","unstructured":"SokerG YilmazC KaratekeF GulekB(2014) An unexpected cause of small bowel obstruction in an adult patient: midgut volvulus.BMJ Case Rep","DOI":"10.1136\/bcr-2014-205178"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.4293\/108680813X13654754534954"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.4293\/108680813X13753907291990"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijscr.2012.10.005"},{"key":"e_1_2_8_50_1","doi-asserted-by":"crossref","unstructured":"HitenKumarPN ShahD PriyankaCBUnusual presentation of midgut malrotation with incidental nutcracker syndrome in adulthood: case report and literature review.BMJ Case Rep(2012)10.1136\/bcr\u201003\u20102012\u20106010228437504543011","DOI":"10.1136\/bcr-03-2012-6010"},{"key":"e_1_2_8_51_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440\u20101827.2012.02842.x"},{"key":"e_1_2_8_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.soard.2011.04.229"},{"key":"e_1_2_8_53_1","doi-asserted-by":"publisher","DOI":"10.1308\/147870810X12699662981915"},{"key":"e_1_2_8_54_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620\u2010008\u20100530\u20105"},{"key":"e_1_2_8_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2007.01.044"},{"key":"e_1_2_8_56_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10140\u2010007\u20100578\u20100"},{"key":"e_1_2_8_57_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440\u20101746.2006.04480.x"},{"key":"e_1_2_8_58_1","first-page":"298","article-title":"Laparoscopic treatment of intestinal malrotation in adults","volume":"9","author":"Seymour NE","year":"2005","journal-title":"JSLS J Soc Laparoendosc Surg"},{"key":"e_1_2_8_59_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440\u20101673.2003.01112.x"},{"key":"e_1_2_8_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0736\u20104679(02)00537\u20101"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-020-05403-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00268-020-05403-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-020-05403-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00268-020-05403-7","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,23]],"date-time":"2023-12-23T15:19:32Z","timestamp":1703344772000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1007\/s00268-020-05403-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,6]]},"references-count":59,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2020,6]]}},"alternative-id":["10.1007\/s00268-020-05403-7"],"URL":"https:\/\/doi.org\/10.1007\/s00268-020-05403-7","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,6]]},"assertion":[{"value":"6 February 2020","order":1,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Informed consent was obtained from all participants in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}