PMC7317621_01
Abdominal computed tomography four years prior to current hospital presentation with incidental classic findings of intestinal malrotation. (a) Transverse plane at the second lumbar vertebral level demonstrating the duodenojejunal junction (DJJ) at the right of the midline and the superior mesenteric vein (SMV) to the left of the superior mesenteric artery (SMA). (b) Transverse plane at the third lumbar vertebral level further demonstrating the duodenojejunal junction (DJJ) at the right of the midline and the superior mesenteric vein (SMV) to the left of the superior mesenteric artery (SMA), as well as the absence of a retroperitoneal third portion of the duodenum (*).
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Disease (MELD) score was 22. During an infectious work-up at the time, an abdominal computed tomography incidentally revealed intestinal malrotation with the classic findings of the duodenojejunal junction at the right of the midline, an abnormal position of the third portion of the duodenum, and an inversed relationship of the mesenteric vessels with the superior mesenteric vein to the left of the superior mesenteric artery (Figure 1).
Abdominal computed tomography at the time of current hospital presentation in (a) transverse and (b) coronal planes demonstrating closed loop small-bowel obstruction in a known background of intestinal malrotation, cirrhosis, and ascites.
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After fluid resuscitation and nasogastric tube decompression, he underwent an abdominal computed tomography which showed small-bowel dilation in the midabdomen associated with two transition points and a swirling appearance of the mesentery in the background of intestinal malrotation (Figure 2).
Abdominal computed tomography after Ladd's procedure in (a) transverse and (b) coronal planes demonstrating intraabdominal loculated ascites (*) in Morrison's pouch, right and left paracolic gutters, and pelvis. There is resolution of small-bowel obstruction after Ladd's procedure with the cecum (c) positioned in the left upper quadrant medial to the descending colon (d).
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The month following discharge was complicated by two readmissions to the hospital for loculated bacterial peritonitis without evidence of small-bowel obstruction recurrence on abdominal computed tomography (Figure 3).