Intestinal malrotation

Case contributed by Mohammadtaghi Niknejad


Chronic abdominal pain.

Patient Data

Age: 75 years
Gender: Male

Retromesenteric D3 segment of the duodenum is absent. Large bowel loops predominantly on the left side and small bowel loops predominantly on the right, compatible with intestinal malrotation

Several cysts are seen at liver less than 26 mm. In addition, an 8 mm calcified focus is noted at segment IVb. 

Several non-enhanced simple cortical cysts are seen at both kidneys, with maximum diameters of 28 mm.

The prostate gland is enlarged.

Degenerative changes as osteophytosis are seen at the lumbar spine.
Grade I spondylolisthesis of L5 on S1 is present. Additionally, mild anterior wedge compression is noted at L2 vertebral body.

Case Discussion

Intestinal malrotation is a congenital anatomical anomaly that results from an abnormal rotation of the gut as it returns to the abdominal cavity during embryogenesis.

Depending on the degree of malrotation, CT may show:

  • absence of a retro-mesenteric (retro-peritoneal) D3 segment of the duodenum 
  • abnormal SMA (smaller and more circular)/SMV relationship
  • large bowel predominantly on the left and small bowel predominantly on the right

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