Right retrocolic intrasaccular duodenum: Is it a novel variant of isolated duodenal nonrotation? A case report

Authors

  • Mirzaman Huseynov Department of Pediatric Surgery, Private Avicenna Hospital

DOI:

https://doi.org/10.47338/jns.v11.978

Keywords:

Newborn, Malrotation, Nonrotation, Isolated duodenal nonrotation, Midgut volvulus

Abstract

Background: Almost all of the studies on anomalies of the midgut rotation and fixation in the literature and related sections in textbooks were designed according to Dott's classification. Focusing only on common rotation anomalies has led to the exclusion and neglect of other rare variants. Isolated pure duodenal nonrotation is such a variant.

Case Presentation: We report a case of an unusual form of isolated pure duodenal nonrotation, in a 3-day-old newborn presenting with bilious vomiting. Ultrasonographic examination revealed the sign of 'whirlpool'. When this finding was evaluated together with bilious vomiting, midgut volvulus was considered and the patient was operated on urgently. Peroperatively, it was observed that the jejunum entered between the leaves of the terminal ileum mesentery. Proximally, the duodenum was located posterior to the right colon in a "sack". This "sack" was surrounded by thick Ladd's bands laterally, mesentery of the ascending colon medially, the posterior surface of the cecum and ascending colon anteriorly, and by the posterior abdominal wall posteriorly.

Conclusion: In isolated duodenal nonrotation, the duodenum may be completely retro-colic. Consequently, the duodenojejunal junction and the ileocecal region may almost overlap. Unlike isolated duodenal nonrotation cases, in the surgical treatment of this variant, separation of Ladd bands alone is not sufficient, additionally, the right colon should be placed in a nonrotation position and care should be taken not to kink the terminal ileum under the cecum.

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References

Ezer SS, Oğuzkurt P, Temiz A, Ince E, Gezer HO, Demir S, et al. Intestinal malrotation needs immediate consideration and investigation. Pediatr Int. 2016; 58:1200-4.

Shah MR, Levin TL, Blumer SL, Berdon WE, Jan DM, Yousefzadeh DK. Volvulus of the entire small bowel with normal bowel fixation simulating malrotation and midgut volvulus. Pediatr Radiol. 2015; 45:1953-6.

Sloan K, Alzamrooni A, Stedman FE, Ron O, Hall NJ. Diagnostic laparoscopy to exclude malrotation following inconclusive upper gastrointestinal contrast study in infants. Pediatr Surg Int. 2020; 36:1221-5.

Stephens LR, Donoghue V, Gillik J. Radiological versus clinical evidence of malrotation, a tortuous tale-10-year review. Eur J Pediatr Surg. 2012; 22:238-42.

Dassinger MS, Smith SD. Disorders of intestinal rotation and fixation. In: Pediatric Surgery. 7th edition. Edited by Coran AG, Caldamone A, Adzick NS, Krummel TM, Jean-Martin Laberge JM. Philadelphia: Elsevier Saunders.: 2012:1111-25.

Strouse PJ. Disorders of intestinal rotation and fixation (‘malrotation’). Pediatr Radiol. 2004; 34:837-51.

Jamieson D, Stringer DA. Congenital and developmental anomalies of the small bowel. In: Pediatric Gastrointestinal Imaging and Intervention. 2nd edition. Edited by Stringer DA, Babyn PA. London: BC Decker Inc.; 2000:311-22.

Snyder WH Jr, Chaffin L. Embryology and pathology of the intestinal tract: presentation of 40 cases of malrotation. Ann Surg. 1954; 140:368–79.

Firor HV, Harris VJ. Rotational abnormalities of the gut: Re-emphasis of a neglected facet, isolated incomplete rotation of the duodenum. Am J Roentgenol Radium Ther Nucl Med. 1974; 120:315-21.

Lewis JE. Partial duodenal obstruction with incomplete duodenal rotation. J Pediatr Surg. 1966; 1:47-53.

Yadav K, Pathak IC. Partial duodenal obstruction in presence of complete rotation of the colon. Am J Gastroenterol. 1979; 71:421-3.

Yang B, Chen WH, Zhang XF, Luo ZR. Adult midgut malrotation: multi-detector computed tomography (MDCT) findings of 14 cases. Jpn J Radiol. 2013; 31:328-35.

Published

2022-01-14

How to Cite

1.
Huseynov M. Right retrocolic intrasaccular duodenum: Is it a novel variant of isolated duodenal nonrotation? A case report. J Neonatal Surg [Internet]. 2022Jan.14 [cited 2022May17];11:5. Available from: https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/978