CT facilitates improved diagnosis of adult intestinal malrotation: a 7-year retrospective study based on 332 cases

Abstract

Objective To classify adult intestinal malrotation by CT. Methods This retrospective study enrolled adults diagnosed with intestinal malrotation who underwent abdominal CT at our institution between June 1, 2013, and August 30, 2020. All patients’ clinical information was recorded. Patients were divided into groups undergoing surgical and conservative management. The duodenum (nonrotation, partial rotation, and malrotation), jejunum, cecum, and the superior mesenteric artery/superior mesenteric vein relationship were reviewed on the CT images of each patient, and classification criteria developed based on the first three items. For each patient, each item was assessed separately by three radiologists. Consensus was required from at least two of them. Results A total of 332 eligible patients (218 men and 114 women; mean age 51.0 ± 15.3 years) were ultimately included and classified into ten types of malrotation. Duodenal partial rotation was present in most (73.2%, 243/332) with only 25% (83/332) demonstrating nonrotation. The jejunum was located in the right abdomen in 98.2% (326/332) of cases, and an ectopic cecum was found in only 12% (40/332, 29 cases with a left cecum, 7 pelvic, and 4 at midline). Asymptomatic patients comprised 56.6% (188/332) of cases, much higher than that in previous studies (17%, n = 82, p < .001), comprised mainly of patients with duodenal partial rotation (80.3%, 151/188). In 91 patients with detailed clinical data available (12 managed surgically and 79 conservatively), a significant difference in malrotation CT categorization was identified (p = .016). Conclusions CT enables greater detection of asymptomatic intestinal malrotation, enabling classification into multiple potentially clinically relevant subtypes.

Unique coexistence of chronic midgut malrotation, mesenteric cyst, and pancreas divisum in a Crohn's disease patient: MR-enterography assessment

“…However, a higher number of variants have been found on CT-scan by Xiong et al. [8] and, on the basis of their outcomes, the configuration of the present case can be classified as a 4a type.…”

“…Nevertheless, Xiong et al. have described ten variants of asymptomatic malrotations in adult patients on the basis of duodenum, jejunum, and cecum localization at CT scan [8] .…”

Intestinal neoplasia reveals intestinal malrotation

“…Our case is an intestinal non-rotation as it involves the entire midgut with the small bowel located on the right side and the colon on the left side of the peritoneal cavity [3,4]. According to Xiong et al [5], a right-sided jejunum is a consistent feature of intestinal malrotation, presenting in 98.2% of cases.…”

“…Intestinal malrotation is a congenital abnormality that occurs during embryogenesis [1,2]. Between the 5th and 11th week, failure of the midgut to complete a 270° rotation around the axis of the superior mesenteric artery (SMA) results in intestinal malrotation [1,[3][4][5]. This term includes several types of malrotation dependent on the embryologic stage of development [3][4][5].…”

“…Intestinal malrotation usually manifests with acute bowel obstruction and midgut volvulus during the first month of life, with an estimated prevalence between 1:200 and 1:6000 of live births [1][2][3][4][5]. In adults, its real incidence is unclear as it is usually asymptomatic and, as in the case presented, detected during investigations motivated by a different clinical scenario [2,4,5]. When present, symptoms include chronic or intermittent nonspecific abdominal pain, nausea with emesis, weight loss, and even volvulus [1][2][3][4][5].…”