Midgut malrotation with hypocalcemic tetany – a most unusual scenario

TB Jagzape1, BB Lakhkar2, AC Lohakare3, N Karande4

Midgut or intestinal malrotation generally present in neonatal period as an acute
obstruction. Beyond neonatal period the presentation is more chronic with non specific
symptoms which include chronic pain in abdomen, bloating, vomiting, diarrhoea or
constipation. We report a case of 11 year girl who presented to us with history of
abnormal movements of both upper and lower limbs and vomiting for last 2 years.
She was diagnosed as a case of seizure disorder and was on anticonvulsants but with
no response. We evaluated her and found out that, the abnormal movements were
actually hypocalcemic tetany. This was due to pseudo- Bartter‘s syndrome i.e. metabolic
alkalosis, hypokalemia, hypochloremia. This metabolic abnormality was due to repeated
vomiting secondary to midgut malrotation, which was diagnosed on Barium meal
follow through. Exploratory laprotomy confirmed the findings. Ladd‘s procedure
was performed and patient was completely relieved of her symptoms. After extensive
search we could find only two such reports of midgut malroation presenting with
hypocalemic tetany.
Key words:- Midgut malrotation, hypocalcemic tetany, pseudo- Bartter‘s syndrome.

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