Retrograde Duodenojejunal Intussusception Caused by Ladd's Bands in an Adult With Intestinal Malrotation: A Rare Variant of Waugh's Syndrome

TL;DR

A rare case of adult intestinal blockage caused by a congenital condition was successfully treated with laparoscopic surgery.

Contribution

Reports a rare cause of retrograde intussusception in adults due to Ladd's bands and intestinal malrotation.

Findings

Ladd's bands caused mechanical traction leading to retrograde duodenojejunal intussusception.

Laparoscopic surgery confirmed the diagnosis and resolved the obstruction without complications.

No neoplastic or ischemic lesions were found, highlighting a non-cancerous cause of the condition.

Abstract

We report a rare case of retrograde duodenojejunal intussusception caused by Ladd's bands in an adult with intestinal malrotation. A 27-year-old man with a history of cerebral palsy and gastrostomy presented with frequent vomiting. Abdominal contrast-enhanced computed tomography showed marked distention of the stomach and duodenum, along with retrograde intussusception of the jejunum into the duodenum at the horizontal segment. No neoplastic lesions were identified as a lead point. A diagnosis of intestinal obstruction due to retrograde intussusception was made, and emergency laparoscopic surgery was performed.

Intraoperative findings revealed nonrotation-type intestinal malrotation. The duodenum was not fixed to the retroperitoneum, and a thickened Ladd's band was pulling the duodenum ventrally. This mechanical traction caused the mobile jejunum to invaginate retrogradely into the duodenum. Transection of the Ladd's band released the traction, resulting in spontaneous reduction of the intussusception. No ischemic changes were observed in the intestine, and the postoperative course was uneventful.

Retrograde intussusception in adults is extremely rare and is typically caused by organic lesions or postoperative factors. In this case, mechanical traction by Ladd's bands combined with intestinal mobility due to malrotation was considered the primary cause. Laparoscopic surgery was effective for both definitive diagnosis and minimally invasive treatment.

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