Intestinal malrotation

Case contributed by Dr Takasa Mei

Presentation

The patient has had lower abdominal pain about once a year for the last 10 years. He was hospitalized to determine the cause of intermittent lower abdominal pain.

Patient Data

Age: 20s
Gender: Male
CT

The duodenum doesn’t exists between the aorta and the superior mesenteric artery . It descends in a linear fashion to the right of the SMA and no ligament of Treitz is formed. The  horizontal duodenal leg was not anchored to the retroperitoneum.

SMA is visualized to the right of SMV.

The small bowel is dilated and congested.

The vascular angle made by the superior mesenteric artery (SMA) and the aorta is acute, which causes compression of the jejunal vein.

DSA (angiography)

The jejunal vein gets compressed by SMA.

Barium

No ligament of Treitz is formed.

Case Discussion

The initial therapy is conservative. Weight gain is encouraged. Weight gain alone can sometimes restore the mesenteric fat pad, thereby increasing the angle of the superior mesenteric artery as it leaves the abdominal aorta. The pain can also be relieved by prone or left lateral decubitus position.

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