PMC4715868_01
Computed tomography imaging of the intra-peritoneal duodenum (C-shaped portion on the red ring)
12905_2015_274_Fig1_HTML.jpg
PMC4715868_01_12905_2015_274_Fig1_HTML.jpg
Fig1
Now we have repeated the CT scan which has evidenced a mobilized intra-peritoneal duodenum (Fig. 1) in all of its portions associated with the cecum/ascending colon predominately lying on left side and the small bowel almost entirely lying on the right side (Fig. 2), with inverted relationship between superior mesenteric vein (SMV) and artery (SMA) - the vein is lying to the left of the artery.
Laparoscopic operative photograph. The bloody perihepatitis associated with adhesions between the liver capsula and abdominal wall
12905_2015_274_Fig3_HTML.jpg
PMC4715868_01_12905_2015_274_Fig3_HTML.jpg
Fig3
Cause of the persistent pain, recurrence of these episodes, the resistance to standard painkiller drugs and normal infective indicator in blood and urine analysis, we decided to perform an exploratory laparoscopy, which evidenced the colon completely mobilized and located on the left side of the abdomen, the duodenum totally intraperitoneal and well-vascularized, but the presence of intense inflammatory process in the hepatic-renal space with bloody fragile viscero-parietal and viscero-visceral adhesions above the Glisson's capsule (Figs. 3 and 4), additionally to the typical PID signs, resulting in inflammatory disorder of the uterus, fallopian tubes and adjacent pelvic structures (Fig. 5).
Laparoscopic operative photograph. The perihepatitis and the mobilized and intra-peritoneal duodenum
12905_2015_274_Fig4_HTML.jpg
PMC4715868_01_12905_2015_274_Fig4_HTML.jpg
Fig4
Cause of the persistent pain, recurrence of these episodes, the resistance to standard painkiller drugs and normal infective indicator in blood and urine analysis, we decided to perform an exploratory laparoscopy, which evidenced the colon completely mobilized and located on the left side of the abdomen, the duodenum totally intraperitoneal and well-vascularized, but the presence of intense inflammatory process in the hepatic-renal space with bloody fragile viscero-parietal and viscero-visceral adhesions above the Glisson's capsule (Figs. 3 and 4), additionally to the typical PID signs, resulting in inflammatory disorder of the uterus, fallopian tubes and adjacent pelvic structures (Fig. 5).