Midgut malrotation with acute appendicitis

Case contributed by Hemali Kumari Lanka
Diagnosis certain


Left iliac fossa pain for two days with high inflammatory markers.

Patient Data

Age: 50 years
Gender: Female

The vertical orientation of the superior mesenteric artery (SMA) and vein (SMV) is noted in initial axial images. Then inversion of the normal relationship between superior mesenteric artery and vein is evident. SMA is on the right and SMV is on the left of the abdomen.

The absence of a retromesenteric segment of the duodenum (D3) in between superior mesenteric vessels and aorta with the duodenojejunal junction is on the right. 

Small bowel loops are seen on the right and large bowel loops on the left of the abdomen. The cecum is located in the left iliac fossa. Enhancing tubular structure arising from the cecal pole confirms an inflamed appendix.  A fluid collection with enhancing wall too noted adjacent to the inflamed appendix suggestive of appendicular abscess formation.

Multiple splenules in the left gastrosplenic region are suggestive of polysplenia. This may be associated with intestinal malrotation.



First axial image: Vertical relationship of superior mesenteric artery and vein; SMA is red color and SMV is blue color.

Second axial image: Inverted relationship between the superior mesenteric vein and artery.

Coronal image: Ileocecal junction with an inflamed appendix on the left side of the abdomen; Terminal ileum is yellow, cecum is white and inflamed appendix is blue color.

Case Discussion

Undetected, asymptomatic cases of intestinal malrotation may present in their adolescent and adult life with midgut volvulus or atypical presentation of a common disease like acute appendicitis.

The surgical findings of this patient confirmed the radiological diagnosis of midgut malrotation with acute appendicitis and appendicular abscess formation.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.