B: Opacified small bowel present almost entirely on the right side. Figure 2 Gastrointestinal contrast studies. A: Upper KPT-330 manufacturer gastrointestinal contrast studies showed malrotation of the small bowel without evidence of the duodenum crossing the lumbar spine. B: All small bowel was noted to be sequestered on the right side of the abdomen. The cecum lay on the left side of the abdomen and the ileum entered it from the right. Based on the diagnosis of malrotation, the patient

consented to exploratory laparoscopy. No segmented gangrene of the small intestine was present. Adhesions surrounding the SMA and cecal bands attaching the duodenum and right colon were noted. The Ladd’s procedure was performed. In detail, the cecum and right colon were rotated medially to expose the duodenum. The base of the mesentery was widened by incising the peritoneum. Then, the duodenum was moved until it was oriented inferiorly toward the right lower quadrant. The entire length of bowel was examined to assure that no other obstructive bands or kinks were present. The small bowel was then placed on the right side of the abdomen, and the colon was placed on the left side of the abdomen. Finally, the appendix was removed. Operative time was 195 minutes with

negligible bleeding. Postoperative course was uneventful. The patient was discharged selleck compound two days later and has remained C-X-C chemokine receptor type 7 (CXCR-7) asymptomatic without recurrence of abdominal pain three months postoperatively. Discussion Malrotation of the intestinal tract is a congenital anomaly referring to either lack of or incomplete rotation of the fetal intestines around the axis of the superior mesenteric artery during fetal development. The malrotaion of the gut and abnormal location of the cecum produces a narrow superior mesenteric vascular pedicle, as opposed to the normally broadbased small bowel mesentery. This narrow superior mesenteric artery takeoff and lack of posterior peritoneal fusion predispose the patient

to subsequent midgut volvulus and obstruction with potential vascular catastrophe. Approximately 85% of malrotation cases present in the first two weeks of life [5, 6]. However, presentation of intestinal malrotation is very rare and its incidence has been reported to be between 0.2% and 0.5% [7]. True incidence of malrotation in older children or adults is unclear, because a number of patients may be asymptomatic. Not all patients with malrotation present with symptoms. Even once the anomaly is discovered, many live without complaint. In adults or older children, the difficulty of diagnosis results from both the absence of specific physical findings and the low frequency in adults [8, 9]. Midgut malrotation in adults presents in numerous ways and the symptoms are non-specific. There are no typical sets of symptoms that are diagnostic of clinical problems.