Unusual presentation of midgut malrotation with incidental nutcracker syndrome in adulthood: case report and literature review

BMJ Case Rep. 2012 Jul 25:2012:bcr0320126010. doi: 10.1136/bcr-03-2012-6010.

Abstract

Malrotation of the midgut is generally regarded as paediatric pathology with the majority of patients presenting in childhood. The diagnosis is rare in adults, which sometimes results in delayed diagnosis and treatment. We present the case of a 28-year-old woman who presented with vomiting and mild acute pain in the abdomen. CT scan showed abnormal location of the midgut and abnormal relation of the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) and duodenal jejunal flexure, confirming midgut malrotation. Peroperative findings showed the duodenum, small bowel loops located on the right side of the abdomen. The caecum and appendix were located at the midline in the epigastrium with the presence of Ladd's bands. SMA right and anterior to SMV whirled around SMA. Incidentally, the intraoperatively dilated left renal vein was compressed between the SMA and the aorta, which was confirmed retrospectively on CT scan with no symptoms related to the condition.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Abdominal Pain / etiology
  • Adult
  • Age of Onset
  • Digestive System Abnormalities
  • Female
  • Humans
  • Incidental Findings*
  • Intestinal Volvulus / complications
  • Intestinal Volvulus / congenital*
  • Intestinal Volvulus / diagnostic imaging
  • Intestinal Volvulus / surgery
  • Laparotomy
  • Renal Nutcracker Syndrome / complications*
  • Renal Nutcracker Syndrome / diagnostic imaging*
  • Renal Nutcracker Syndrome / surgery
  • Tomography, X-Ray Computed
  • Vascular Malformations / diagnostic imaging
  • Vomiting / etiology

Supplementary concepts

  • Volvulus Of Midgut