Appendicitis in adults with incidental midgut malrotation: CT findings

Ely, Anna Ben; Gorelik, Natalia; Cohen-Sivan, Y.; Zissin, Rivka; Carpineta, Lucia; Osadchy, Alexandra; Gayer, Gabriela

doi:10.1016/j.crad.2013.07.001

Cited by 27 publications

(30 citation statements)

References 13 publications

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“…In addition, the anatomical variations exhibited in such cases may also be responsible for atypical presentations of common surgical pathology such as appendicitis 2. This case report highlights the typical CT findings of partial bowel malrotation that will be of benefit to both surgeons and radiologists alike.…”

Section: Descriptionmentioning

confidence: 70%

“…Adults are often asymptomatic, and such cases are usually diagnosed as incidental findings when imaged for other conditions 2. Ultrasound, CT or upper gastrointestinal studies may identify the typical characteristics 3…”

Section: Descriptionmentioning

confidence: 99%

“…Further signs include an abnormal caecal position, right-sided duodenal–jejunal junction and small bowel, left-sided colon, hypoplasia of the pancreatic uncinated process and an absence of transverse colon crossing the abdomen 2 3…”

Section: Descriptionmentioning

confidence: 99%

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Partial malrotation of the bowel in an adult patient presenting with abdominal pain

Gemmell

2015

BMJ Case Reports

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DESCRIPTIONA 60-year-old man was presented with colicky upper left abdominal pain and vomiting. Haematology and biochemistry were unremarkable and there had been no recent change in bowel habits.An initial non-contrast abdominal CT, performed due to the provisional diagnosis of left renal colic, revealed a midline caecum (figure 1) and an absence of small bowel in the left abdomen (figure 2). The superior mesenteric vein was located anterior to the superior mesenteric artery (figure 3) and the duodenal-jejunal junction was present on the right side, failing to cross the midline (figure 4). The findings were consistent with partial malrotation of the bowel. No renal calculi were present.A subsequent contrast-enhanced CT of the abdomen revealed no evidence of bowel ischaemia, and the superior mesenteric artery and vein were both patent. The pyloric wall was irregularly thickened circumferentially (figure 5) with loss of clarity of the adjacent mesenteric fat and prominent lymph nodes. Subsequent oesophagogastroduodenoscopy confirmed gastric carcinoma.Partial malrotation of the bowel results when the embryonic mid-gut fails to complete the normal 270°of counter clockwise rotation during gestation.1 Adults are often asymptomatic, and such cases are usually diagnosed as incidental findings when imaged for other conditions. 2 Ultrasound, CT or upper gastrointestinal studies may identify the typical characteristics. As highlighted in this case, recognition of partial malrotation in symptomatic patients should therefore prompt a thorough search for additional intra-abdominal pathology. In addition, the anatomical variations exhibited in such cases may also be responsible for atypical presentations of common surgical pathology such as appendicitis. 2This case report highlights the typical CT findings of partial bowel malrotation that will be of benefit to both surgeons and radiologists alike.

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Section: Descriptionmentioning

confidence: 70%

Section: Descriptionmentioning

confidence: 99%

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Partial malrotation of the bowel in an adult patient presenting with abdominal pain

Gemmell

2015

BMJ Case Reports

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“…At the 12th week, the intestinal segments were fixed as the ascending and descending colon on the right and left quadrants, respectively [6]. According to stringer classification which is based on the embryological state of development, there are three different types of MM as type I (nonrotation), type II (duodenal malrotation), and type III (combined duodenal and cecal malrotation) [7]. In this case, there was type I MM which includes left positioned cecum and ascending colon with right-sided duodenojejunal junction accompanied by inverted position of the superior mesenteric vessels and hypoplasia of the uncinate process of the pancreas.…”

Section: Discussionmentioning

confidence: 99%

Midgut Malrotation Causing Intermittent Intestinal Obstruction in a Young Adult

Bektaşoğlu

İdiz

Hasbahçeci

et al. 2014

Case Reports in Surgery

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“…More specifically, there is a scarcity of information regarding acute progression of malrotation into volvulus after abdominal surgery for a separate cause. Only a handful of other cases [3–6] describe patients to have appendicitis with an incidental malrotation. And, among those who underwent surgery, the malrotation was never treated.…”

Section: Discussionmentioning

confidence: 99%