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

Abstract

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.

Midgut malrotation complicated by small bowel obstruction in an 80-year-old woman: A case report

“…An abnormal anatomical relationship between the SMA and SMV, and the twisting of small bowel and mesentery around the SMA referred to as the “whirlpool sign” on CT scan [12], should prompt consideration of an underlying malrotation. Other findings include right-sided duodenojejunal junction failing to cross the midline, abnormal cecal position, left-sided colon, and pancreatic uncinate process hypoplasia [11,13]. Upon further review of our patient’s prior CT imaging for another indication in 2009, we observed several findings consistent with malrotation, most notably the abnormal relationship of the SMV to the SMA, and the right-sided duodenum (Fig.…”

Midgut malrotation: a rare presentation of bowel obstruction in the adult

“…In adults, CT is preferred. [ 2 , 11 ] There are a few features which can be seen that cinches the diagnosis such as the ‘whirl pool’ sign seen in intestinal volvulus; the inverse relationship (SMV rotation sign) between the superior mesenteric vein (SMV) and artery (SMA), where the SMV lies anterior and to the right of the SMA [ 12 ] There is also right sided small bowel, a right sided DJ flexure and cecum to the left [ 8 ]. Garcelan et al .…”