Novel variant of reversed midgut rotation - retro-arterial proximal jejunum and transverse colon: a case report and review of the literature

J Med Case Rep. 2018 Sep 14;12(1):261. doi: 10.1186/s13256-018-1802-0.

Abstract

Background: Reversed rotation of the midgut is the rarest variation of midgut malrotations, which are congenital disorders that result from aberrant rotation and fixation of the midgut during embryological development. Common complications of these disorders are small bowel obstruction by volvulus or peritoneal bands, usually occurring in early infancy.

Case presentation: A 23-year-old Caucasian woman presented with recurrent abdominal pain. A contrast-enhanced multidetector computed tomography study revealed a novel variant of reversed rotation of the midgut. Besides the specific finding of a retro-arterial transverse colon, we also found the proximal jejunum to cross posterior to the mesenteric root, a variation that has not been reported in the literature so far. In this case, substantial symptomatic relief was achieved with conservative management.

Conclusions: The hypothesis of a double reversed rotation of the pre-arterial segment of the umbilical loop around the superior mesenteric artery axis provides a possible explanation for this anomaly. There is no evidence-based consensus on the management of patients presenting with non-symptomatic or mildly symptomatic intestinal malrotations. In this case, radiologic and clinical presentations excluded acute small bowel obstruction, and surgical intervention was avoided.

Keywords: Anatomical anomaly; Embryology; Intestinal malrotation; Midgut development; Rare congenital disorder; Reverse rotation variant; Small bowel obstruction.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Abdominal Pain / etiology*
  • Abdominal Pain / therapy
  • Colon, Transverse / abnormalities
  • Colon, Transverse / diagnostic imaging*
  • Colon, Transverse / enzymology
  • Digestive System Abnormalities / complications
  • Digestive System Abnormalities / diagnostic imaging*
  • Digestive System Abnormalities / embryology
  • Female
  • Humans
  • Intestinal Volvulus / congenital
  • Intestinal Volvulus / diagnostic imaging*
  • Jejunum / abnormalities
  • Jejunum / diagnostic imaging*
  • Jejunum / embryology
  • Multidetector Computed Tomography
  • Recurrence
  • Rotation
  • Young Adult