The Late Diagnosed Intestinal Malrotation by Abdominal Tomography In An Adolescent

Abstract

Introduction: Intestinal malrotation is an anomaly that often manifests in newborn and infant childhood. This anomaly, which is rarely seen in older children and adults, is usually detected incidentally during imaging studies or during laparotomy. This article is presented with the aim of emphasizing the Computarised Tomography (CT) imaging for intestinal malrotation an adolescent patient with mesenteric volvulus. Case Report: A sixteen-year-old male patient presented with epigastric pain and bilious vomiting after feeding. In ultrasonography (US), intestinal loops were surrounding along the superior mesenteric artery (SMA) and venous (SMV) vessels tract. In CT, it was noted that SMA marks a whirl sign in the midline of the abdomen. At laparotomy, there were found 360° torsion of small intestine, due to intestinal malrotation. Ladd procedure was performed. Conclusion: In cases of intestinal malrotation, preoperative diagnosis can be difficult because of the lack of specific findings in the physical examination. The delayed diagnosis may be lead to volvulus and intestinal necrosis. The diagnosis of malrotation can brought to mind at an early age but it may be delayed in later ages. In practiced hand, the evaluation of vessels traseries by detailed US and contrast-enhanced CT are characteristics of malrotation diagnosis.