Presentation
Long history of intermittent abdominal pain and constipation.
Patient Data
Ultrasound demonstrated a reversal of the superior mesenteric vein/artery axis, with the SMV lying on the left side. The small bowel was seen to be right-sided, and the cecum could not be identified in the right iliac fossa.
The upper GI contrast study demonstrates that the duodenum does not cross the midline as would be expected, instead extending to the right side of the abdomen. Delayed images show the right-sided/central small bowel and the ileocecal junction in the left iliac fossa with the left-sided proximal colon.
Case Discussion
Appearances are those of small bowel malrotation, although it is important to note that there was no evidence of midgut volvulus either clinically or radiologically.
While the reversal of the SMA/SMV axis on ultrasound is often considered a feature of small bowel malrotation, it can be normal in 29% of patients with proven malrotation, and it can be abnormal in 21% of patients with normal rotation. It is therefore worth diagnosing definitively with fluoroscopy if there is a clinical or radiological concern.
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