eP406 - Clinical Presentation and Surgical Outcomes of Intestinal Malrotation with Cocoon Deformity

Sunday, June 2, 2024

2:09 PM – 2:14 PM ET, USA

Location: Baltimore Convention Center, Room 318-320

ePoster Presenter(s)

Maxwell D. Mirande, D.O. (he/him/his)

General Surgery Resident
Mayo Clinic Rochester
Mayo Clinic Rochester
Rochester, MN, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Jacob W. Baxter, MD (he/him/his)

Resident
Mayo Clinic Rochester
Mayo Clinic
Rochester, MN, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
MM

Mitchell H. Mirande, D.O.

General Surgery Resident
TriHealth Good Samaritan Hospital
Fort Thomas, Kentucky, United States

Disclosure information not submitted.
Eric Joseph Dozois, Professor of Surgery

Chair, Colon and Rectal Surgery
Mayo Clinic
Rochester, Minnesota, United States

Disclosure information not submitted.

Senior Author(s)

WP

William Perry, MBChB MPH FRACS FACS FASCRS (he/him/his)

Assistant Professor
Mayo Clinic
Mayo Clinic
Rochester, MN, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Purpose/Background: Cocoon deformity is a rare variant of intestinal malrotation in which a portion of the small intestine is encapsulated in a peritoneal sac. Literature describing the presentation and surgical outcomes of patients with this condition is limited to case reports. Therefore, we aimed to better characterize the clinical presentation and outcomes in patients with this rare variant who have undergone surgery.Methods/Interventions: A retrospective review was undertaken of all patients who underwent surgical management for intestinal malrotation with cocoon deformity at a large tertiary care center from 2010-2022. Patient demographics, clinical presentation, diagnostic workup, and operative outcomes were abstracted from the electronic medical record.Results/Outcomes: Seven patients (85.7% female) were identified. All were white with a median age of 37 years (interquartile range [IQR] 21-59). Most were symptomatic (85.7%) with abdominal pain (71.4%), nausea (42.9%), and vomiting (42.9%) being the most common symptoms. One patient presented acutely requiring emergent surgical intervention. Intestinal malrotation was diagnosed on computed tomography in five patients (71.4%), upper gastrointestinal follow-through in five patients (71.4%), and magnetic resonance imaging in one patient. One patient was diagnosed intraoperatively. No preoperative radiology reports noted a cocoon deformity.

A laparoscopic Ladd procedure was attempted in all patients with two patients requiring conversion to open. The median operative time was 112 min (IQR 94-189) with a median estimated blood loss of 25 cc (IQR 20-100). The median length of stay was 2 days (IQR 1-10). Postoperative complications included ileus (n=2, 28.6%), 30-day readmission (n=2, 28.6%), and fascial dehiscence (n=1, 14.3%). There were no mortalities. Five patients (71.4%) had complete resolution of symptoms, while two patients had persistent symptoms. The median follow-up was 59.6 months (IQR 16.7-84.8).Conclusion/

Discussion: Cocoon deformity in patients with intestinal malrotation leads to significant non-specific abdominal symptoms. A minimally invasive Ladd procedure is safe and appears to be effective in resolving symptoms in most patients.