Multimodal imaging in the diagnosis and evaluation of intestinal malrotations: a case report

Midgut malrotation is a congenital anomaly referring to either lack of or incomplete rotation of the fetal intestines around the axis of the superior mesenteric artery during fetal development. The diagnosis is usually performed with several modalities such as barium studies, computed tomography (CT) scans, angiography, and often emergent laparotomy. In the current study, we present a case of malrotation in an adult presenting with chronic abdominal pain. A 38-year-old woman presented with cramping abdominal pain localized in the right iliac fossa. She reported a normal physiological anamnesis and had no history of relevant organ pathologies.Upper gastrointestinal Rx contrast studies showed malrotation of the small bowel without evidence of duodenum crossing the lumbar spine, lack of duodenojejunal flexure, and the right colon was localized in the left abdominal side. The left colon showed a normal localization. The last loop of the small intestine converged in the ileocecal valve at the right colonic side. All small bowel was sequestered on the right abdominal side. Abdominal CT with contrast confirmed the diagnosis of intestinal malrotation. Because often intestinal malrotation occurs in association with other gastrointestinal abnormalities, such as jejunal and duodenal stenosis or atresia and annular pancreas, the patient underwent Wirsung magnetic resonance imaging which did not reveal the presence of annular pancreas. The Wirsung’s duct was anterior of the intrapancreatic segment of the coledoc duct leading to a mild functional substenosis ab-estrinseco. A multimodal imaging strategy proved to be useful for the diagnosis of intestinal malrotation in an adult afflicted by chronic vague abdominal pain.