Incidental intestinal malrotation in an adult: Midgut volvulus

Abstract

Intestinal malrotation is a developmental anomaly characterized by a midgut fixation disorder and failure to complete its normal fetal rotation around the superior mesenteric artery inside the peritoneal cavity. Malrotation is a rare cause of mechanical intestinal obstruction in adults. It may manifest as an emergency condition or with chronic abdominal symptoms. Although its diagnosis remains difficult, early diagnosis and treatment usually yield favorable outcomes. Intestinal malrotation rarely has an asymptomatic course, in which the diagnosis is usually made incidentally. Multislice computed tomography is quite helpful for making a correct diagnosis. In this study, we reported a 56-year-old patient incidentally who was detected to have intestinal malrotation and was managed symptomatically after presenting at our clinic with signs and symptoms of intestinal obstruction; we also provided a discussion of the relevant literature.

Figure 1. a–c

(a) Stomach appears distended by filling of its lumen by the orally administered contrast agent. (b) Duodenojejunal junction is located to the right of the midline; the whirlpool sign formed by the proximal jejunal segment and the surrounding mesenteric fat tissue around SMA is seen. (c) SMA (filled arrow) is visualized to the right of SMV (empty arrow)

Figure 2

MR Enterography shows the typical whirlpool sign (Axial fat-suppressed T2A sequence)