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

Abstract

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.