Intestinal malrotation as an incidental finding on CT in adults

Abstract

Intestinal malrotation can be diagnosed on CT by the anatomic location of a right-sided small bowel, left-sided colon, an abnormal relationship of the superior mesenteric vessels, and aplasia of the uncinate process. Awareness of these abnormalities is necessary to diagnose this anomaly. It should be sought in patients with a situs problem, inferior vena cava anomalies, polysplenia, or preduodenal portal vein. Although usually an incidental finding, it is important to diagnose such a malrotation because it may cause abdominal symptoms. Also, knowledge of associated vascular anomalies is important when abdominal surgery is planned.

Má rotação intestinal em adulto: relato de caso

“…. Besides these, there are other diagnostic examinations such as ultrasound of the abdomen (also evaluating the inverse relationship between the mesenteric vessels) 3,6,9,10 , angiography 3,6 and laparoscopy 7 . In acute cases, however, the diagnosis in most cases is still done by laparotomy 3 .…”

“…This case had the diagnosis clarified by contrast tomography of the abdomen. This exam has been increasingly requested and shows characteristic changes of anatomical parameters, such as: inverse relationship between the superior mesenteric vessels (vein is located to the left of the artery) 1,4,10 , absence or hypoplasia of the uncinate process of the pancreas 4,10 and mislocation of the bowel 4 . However, the diagnosis could have been done by radiographic contrast study of upper gastrointestinal tract, which according to many authors, is the gold standard for diagnosis of intestinal malrotation 1,4 , with accuracy exceeding 80% 2,6 and in some studies reaching 100%…”

Má rotação intestinal em adulto, relato de caso e revisão da literatura

“…Este exame vem sendo cada vez mais solicitado e demonstra alterações de parâmetros anatômicos característicos, tais como relação inversa entre os vasos mesentéricos superiores (veia está situada à esquerda da artéria) 1,4,10 , ausência ou hipoplasia do processo uncinado do pâncreas 4,10 e alterações na disposição das alças intestinais 4 . Porém, o diagnóstico poderia ter sido feito através de raio-X contrastado do trato gastrintestinal alto, o qual segundo muitos autores, é o exame padrão-ouro para o diagnóstico de má rotação intestinal 1,4 , tendo acurácia superior a 80 % 2,6 e em alguns estudos atingindo 100 % 5 .…”

“…O achado mais importante a ser observado é a junção duodeno-jejunal, a qual não cruza a linha média e fica localizada à direita da coluna vertebral 1,4,6 . Além destes, há outros exames para o diagnóstico tais como ultrassonografia de abdômen (também avaliando a relação inversa entre os vasos mesentéricos) 3,6,9,10 , angiografia 3,6 e a videolaparoscopia 7 . Nos casos agudos, no entanto, o diagnóstico na maioria das vezes continua a ser feito através da laparotomia 3 .…”

Malrotation and abdominal pain: A diagnosis eluding the unprepared mind

“…During adult life, IM may be an incidental finding during investigation, viz., upper GI contrast study or contrastenhanced computed tomography (CECT) scan [9] for some other disease or discovered incidentally during elective or emergency surgery for a different etiology [10][11][12]. When suspected, upper GI contrast study is the choice of investigation for diagnosing this condition.…”