Double reverse intestinal malrotation: a novel rotational anomaly and its surgical correction

Nehra, Deepika; Zeineh, Michael; Rodriguez, Filiberto; Dutta, Sanjeev

doi:10.1016/j.jpedsurg.2006.10.061

Cited by 5 publications

(9 citation statements)

References 9 publications

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“…2b ). This variant differs from an earlier described case with the suggested name of double reversed intestinal rotation, where only the retro-arterial segment seems to complete a 360 degree rotation around the mesenteric root [ 14 ]. In view of this latter and our variant of reversed rotation, presumably, a multitude of combinations from partial to complete reversed rotations of the pre-arterial or retro-arterial segment are imaginable, in addition to the currently believed classic appearance of reversed intestinal rotation.…”

Section: Discussioncontrasting

confidence: 67%

“…The aim of the Ladd’s procedure is to relieve already present bowel obstruction and to widen the base of the mesentery to prevent midgut volvulus [ 9 ]. The surgical approaches described to correct reversed rotations further include resection and displacement of the transverse colon anterior to the mesenteric root [ 14 ] or right hemicolectomy with ileotransverse anastomosis [ 20 ]. In other cases, extensive resections or antemesenteric transposition of the transverse colon was avoided [ 21 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

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Novel variant of reversed midgut rotation – retro-arterial proximal jejunum and transverse colon: a case report and review of the literature

et al. 2018

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BackgroundReversed rotation of the midgut is the rarest variation of midgut malrotations, which are congenital disorders that result from aberrant rotation and fixation of the midgut during embryological development. Common complications of these disorders are small bowel obstruction by volvulus or peritoneal bands, usually occurring in early infancy.Case presentationA 23-year-old Caucasian woman presented with recurrent abdominal pain. A contrast-enhanced multidetector computed tomography study revealed a novel variant of reversed rotation of the midgut. Besides the specific finding of a retro-arterial transverse colon, we also found the proximal jejunum to cross posterior to the mesenteric root, a variation that has not been reported in the literature so far. In this case, substantial symptomatic relief was achieved with conservative management.ConclusionsThe hypothesis of a double reversed rotation of the pre-arterial segment of the umbilical loop around the superior mesenteric artery axis provides a possible explanation for this anomaly. There is no evidence-based consensus on the management of patients presenting with non-symptomatic or mildly symptomatic intestinal malrotations. In this case, radiologic and clinical presentations excluded acute small bowel obstruction, and surgical intervention was avoided.

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Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Novel variant of reversed midgut rotation – retro-arterial proximal jejunum and transverse colon: a case report and review of the literature

et al. 2018

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“…In the less common prearterial subtype, the prearterial segment is reduced first into the abdomen and is located in the left abdominal region anterior to the SMA. The postarterial segment ends up in the right abdomen (6,7). In our case, the transverse colon was located behind the superior mesenteric vessels and the cecum and duodenum were positioned in the right supramesocolic compartment of the abdominal cavity.…”

Section: Discussionmentioning

confidence: 67%

Multidetector CT Findings of Retroarterial Reversed Intestinal Rotation in an Adult: A Case Report

Sung

Chae

et al. 2011

J Korean Soc Radiol

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Reversed intestinal rotation is one of the least common intestinal developmental anomalies, and accounts for 4% of all malrotation cases (1). In 1923, Dott et al. (2) proposed that in reversed rotation, the normal 270 counterclockwise rotation is replaced by a 90 counterclockwise rotation followed by a 180 clockwise rotation, resulting in a net 90 clockwise rotation. Intestinal malrotation is usually diagnosed during infancy and childhood as a result of acute symptoms induced by complications including intestinal obstruction or volvulus. Adults with rotational anomalies are asymptomatic and are usually founded incidentally during an imaging evaluation or laparotomy for coincidental disease (3).Only a few cases of reversed intestinal rotation have been reported in surgical and internal medicine literatures. To the best of our knowledge, there are no reports of MDCT findings concerning reversed intestinal rotation (4-6). We report a case of reversed rotation in a 38-year-old man, focusing on the first MDCT findings alongside a literature review. Case ReportA 38-year-old man visited the outpatient department of our hospital with complaints of nausea, intermittent vomiting, recurrent dyspepsia, and abdominal discomfort. Upon physical examination, his abdomen was not distended, and he had normal bowel sounds. After undergoing endoscopy, he was initially diagnosed with gastritis and gastroesophageal reflux and had been treated. However, his recurrent dyspepsia and abdominal discomfort had not been completely relieved.Using a 128-row detector MDCT scanner (definition AS+, Siemens Medical Solutions, Forchheim, Germany), CT scans of the abdomen and pelvis were obtained in the arterial and portal venous phases after the intravenous injection of contrast agent (Ultravist 300, Bayer Schering Pharma, Berlin, Germany) and optimal colon distension. Colon distension with carbon dioxide was achieved using an automated insufflator and a small rectal catheter with a retention balloon Intestinal malrotation is an uncommon cause of abdominal pain in adults. More so, reversed intestinal rotation is one of the least common malrotation anomalies. A few cases of reversed intestinal rotation have been reported only in surgical and internal medicine literatures. To the best of our knowledge, MDCT findings concerning reversed intestinal rotation had never been reported. We present a 38-year-old man with retroarterial reversed intestinal rotation with MDCT findings.

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“…As proposed by Estrada, it takes place when the postarterial bowel segment reduces back into the abdomen first; thus, the transverse colon is brought behind the duodenum and the Superior Mesenteric Artery [ 3 ]. Reverse intestinal rotation most commonly presents in infancy or early adulthood with intestinal obstruction and volvulus of nonfixed cecum and colonic obstruction by superior mesenteric vessels [ 4 ]. Although intestinal malrotation in adulthood is an extremely uncommon cause of bowel obstruction, several case reports have been reported [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Reversed Intestinal Rotation Presented as Bowel Obstruction in a Pregnant Woman

Aranovich

Schrier

2015

Case Reports in Surgery

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A rare case of complete large bowel obstruction in a pregnant woman, without previous surgical history, due to previously undiagnosed reversed intestinal rotation is presented. The young woman was admitted with progressive nausea and vomiting which did not respond to conventional therapy. Her plain abdominal film revealed signs of small bowel obstruction. On laparotomy, her transverse colon was found to be located beneath the root of small bowel mesentery and completely obstructed by congenital fibrous bands. Postoperative recovery was unremarkable. Surgery for this unusual developmental anomaly is discussed.

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Double reverse intestinal malrotation: a novel rotational anomaly and its surgical correction

Cited by 5 publications

References 9 publications

Novel variant of reversed midgut rotation – retro-arterial proximal jejunum and transverse colon: a case report and review of the literature

Novel variant of reversed midgut rotation – retro-arterial proximal jejunum and transverse colon: a case report and review of the literature

Multidetector CT Findings of Retroarterial Reversed Intestinal Rotation in an Adult: A Case Report

Reversed Intestinal Rotation Presented as Bowel Obstruction in a Pregnant Woman

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