Reversed Intestinal Rotation Presented as Bowel Obstruction in a Pregnant Woman

Abstract

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.

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

“…With the cecum located in the mid-abdomen, close to the midline, a mobile cecum with a narrow mesenteric attachment was presumably also present in our patient. Other complications observed in reversed rotation anomalies are obstruction of the transverse colon by the SMA in the retro-arterial tunnel [ 17 – 21 ], volvulus (especially ileocecal) [ 15 – 19 ], and duodenojejunal obstruction. The latter may occur due to paraduodenal herniation or fibrous peritoneal bands [ 15 , 16 , 19 , 20 , 22 , 23 ].…”

“…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 ].…”

Reversed intestinal malrotation presenting as bowel obstruction in pregnancy: Case report and literature review

“…As proposed by Estrada, it takes place when the post-arterial bowel segment reduces back into the abdomen first; thus, the transverse colon is brought behind the duodenum and the Superior Mesenteric Artery. A case of intestinal malrotation in a pregnant woman was previously described in 1927 by Donald [ 9 ]. The authors present a rare case of complete large bowel obstruction with no prior surgical history caused by previously undiagnosed reversed intestinal rotation.…”