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Publications

Case Reports Journal Article Ahead of print

PubMed: 42924078 DOI: 10.1159/vis/aeyag001

Intestinal Malrotation as a Rare Cause of Recurrent Acute Pancreatitis: A Case Report and Literature Review.

Visc Med

Authors: Tengis Tschaidse, Simon Sirtl, Liva Rudroff, Didem Saka, Felix O Hofmann, Yevgeniy Dikhtyar, Max Seidensticker, Bernhard W Renz, Jens Werner, Julia Mayerle, Hanno Nieß, Georg Beyer

Affiliations

  • Department of General, Visceral and Transplantation Surgery, University Hospital, LMU Munich, Munich, Germany.
  • Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.
  • Department of Radiology, University Hospital, LMU Munich, Munich, Germany.

Abstract

INTRODUCTION

Due to improvements in endoscopic diagnostics and genetic testing, an underlying etiology can be identified in most cases of recurrent acute pancreatitis (RAP). Intestinal malrotation as an underlying cause of RAP in adults is exceedingly rare. Patients undergo multiple diagnostic procedures and interventions before the diagnosis is established, highlighting the importance of interdisciplinary collaboration for timely recognition and treatment.

CASE PRESENTATION

We reviewed the literature (MEDLINE, Embase, SCOPUS; inception-15 July 2025) for RAP associated with intestinal malrotation, analyzed pathophysiology, imaging findings, and surgical outcomes. These insights were illustrated through the clinical course of a 21-year-old male with ten episodes of RAP over 4 years. Key mechanisms include intermittent duodenal obstruction by Ladd's bands and insufficient outflow into the jejunum. Ladd's procedure - open or laparoscopic - with optional duodenopexy prevented recurrence in all three cases published to date. In our patient, extensive workup including EUS, genetic testing, and cholecystectomy did not prevent recurrence. After the diagnosis of duodenal malrotation was established, Ladd's procedure with band division and repositioning of the duodenum led to 12 months of symptom-free follow-up. This rare entity illustrates a diagnostic and therapeutic challenge, as pancreatitis cases that ultimately require surgical treatment, aside from biliary pancreatitis, might easily be overlooked in current practice.

CONCLUSION

Evidence on diagnostic and therapeutic approaches for patients with presumed idiopathic RAP and multiple disease recurrences remains limited due to the rarity of this condition. Intestinal malrotation should be considered in idiopathic RAP after excluding common causes. Early cross-sectional imaging, a multidisciplinary case discussion, and timely surgical referral can help prevent disease recurrence.

MeSH

Research Design, Genetic Testing, Pancreatitis, Diagnosis, Therapeutics