Presentation
Right lower quadrant pain of acute onset with clinical concern for acute appendicitis. History of celiac disease.
Patient Data
Colon seen in the left abdomen.
Small bowel loops seen in the right abdomen.
The duodenum does not cross the mid line and small bowel loops located within the right abdomen.
Large bowel loops located within the left abdomen and pelvis.
A single small bowel loop with mild wall thickening and narrowed lumen is noted in the mid abdomen, with no evidence of surrounding inflammatory changes, likely represent focal peristalsis.
Cecum is located in the pelvis and the appendix appears normal.
The superior mesenteric artery is located to the right of the superior mesenteric vein.
Small amount of free fluid seen in the pelvis. No other significant findings are appreciated.
Case Discussion
This is a typical presentation of intestinal mal-rotation as incidental finding on imaging studies undergone for other purposes. In our case, the CT scan study was ordered to rule out the possibility of acute appendicitis or bowel abnormality secondary to celiac disease. It is worth mentioning here, that although it is very rare at this age to have a midgut volvulus secondary to mal-rotation, it is important to exclude the possibility of associated bowel obstruction/ischemia.
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