PMC9596249_01
CT scan in Case 1. (a) There was no duodenal horizontal section. The duodenal descending section and jejunum (arrow) were located under the ascending colon (arrowhead). (b) The jejunum (dotted area) was located in the right upper quadrant. (c) The ascending colon (arrowhead) was recognized at the normal position. (d) The part where the jejunum excluded to the retroperitoneal side comes out into the abdominal cavity was narrowed like a "hernia defect" (dotted area). (e) The small intestine that emerges into the abdominal cavity runs to the left and then reached the ileocecal region.
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fig1
CT showed the features of the intestinal malrotation, and the patient was admitted to our hospital on the same day (Figures 1(a)-1(e)).
Upper GI series revealed that the duodenal descending section and the jejunum are located in the right upper abdomen, and the remaining intestine runs from the lower right abdomen to the left side.
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fig2
Upper gastrointestinal (GI) series confirmed the duodenal descending section and the jejunum as a mass in the right-upper abdomen (Figure 2).
The operative findings in Case 1. (a) The small intestine run through the hernia defect (dotted area), which consists of the fibrotic adhesions between the retroperitoneum and the colon mesentery. Cecum (arrowhead) and terminal ileum (arrow) were recognized over the hernia gate. (b) The hernia defect (dotted area) was dissected. (c) The outside adhesion of the right colon and the abnormal retroperitoneal bands was also dissected. After that, the duodenum (yellow arrow) and the jejunum (yellow arrowhead) were recognized under the ascending colon (blue arrow). (d) There was a severe curve (dotted area) at the transition from the proximal side of the duodenum (yellow arrow) to the distal side (yellow arrowhead), and a membrane structure ran across the duodenum and the pancreas head (blue arrow). (e) The transition between the proximal side of the duodenum (yellow arrow) and the distal side (yellow arrowhead) was straightened. The bleeding was recognized at the pancreatic head (blue arrow). (f) The small intestinal mesentery (dotted area) was recognized at the right side, and the transverse colon (blue arrow) was at the left side. The root of the small intestinal mesentery (yellow arrow) was fully widened.
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fig3
No fixation of the intestine to the retroperitoneum was performed (Figures 3(a)-3(f)).
Upper GI series revealed a passage disorder of the duodenal descending portion (dotted area).
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fig4
On POD 6, upper GI series was performed and passage disorder of the duodenum was observed (Figure 4).
EGD findings in Case 1 on POD15. (a) EGD could not pass through the duodenal descending portion (dotted area). (b) Extrinsic compression with redness (arrow) was seen at the duodenal descending portion.
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fig5
The scope could not pass through the duodenum because of the external compression (Figures 5(a) and 5(b)).
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