Intestinal non-rotation

Case contributed by Himanshu Mishra
Diagnosis certain

Presentation

The patient presented with on-and-off low grade abdominal pain since 2 months.

Patient Data

Age: 55 years
Gender: Female
ct

CECT images (axial and coronal views) show the small bowel loops occupying the right side of abdomen and large bowel loops lying on the left side. Duodenojejunal (DJ) junction is seen on the right. Appendix (with a few appendicoliths) is seen in the left iliac fossa.

Superior mesenteric vein is seen anterior to the superior mesenteric artery.

Case Discussion

During embryological development, the gut herniates out of the abdominal cavity and undergoes a complex 270º counterclockwise rotation around the superior mesenteric vessels. Thereafter, bowel returns to the abdominal cavity, with DJ junction to the left, appendix to the right, small bowel loops centrally, and large bowel loops peripherally. 

Abnormal rotation and return of the bowel loops result in non-rotation or malrotation.

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