Changez Hakeem Khan, Atta Ur Rehman, Sardar Hussain.
Malrotation of the gut with Tuberculous Stricture.
J Coll Physicians Surg Pak Jan ;13(6):350-1.

Malrotation of the gut is a congenital anomaly of the gastrointestinal tract and usually present with obstruction in early childhood. Late presentation may come into light for associated pathology. We report a case that had developed obstruction due to tuberculous stricture and not due to the anomaly itself.

Case Report: A 22-year-old male presented with recurrent attacks of abdominal pain and fullness for the last one year. It was accompanied by periodic constipation and audible borborygmi. On examination abdomen was mild to moderately distended with visible peristalsis and percussion notes were hyperresonant. Abdominal x-ray showed multiple fluid levels and large gas shadows. TLC was 9000 with 40% lymphocytes. On surgery gut was found to be malrotated with caecum lying in the left side of the abdomen adherent to the colon. It was accompanied by a stricture of the terminal ileum extending into the caecum with mesenteric lymphadenopathy. Adhesions were released and ileotransverse anastomosis was done to bypass the stricture. Appendectomy was performed because if it become inflamed later, there would have been diagnostic difficulties due to unusual site. Biopsy was taken from the mesenteric lymph nodes and the result showed chronic caseating granulomatous inflammation consistent with tuberculosis.

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