We diagnosed congenital intestinal malrotation, which rarely occurs in adults or older children, by using several modalities such as barium studies, computed tomography, and laparoscopy. We describe the clinical and radiological data of this patient followed by a brief review of the literature. This case report serves to demonstrate the benefits of laparoscopic surgery for malrotation. Also, the present case reminds us that intestinal malrotation should be considered in the differential diagnosis of a wide variety of symptoms and should

be treated promptly once the diagnosis has been confirmed. Presentation of case A 14-year-old man presented to our emergency center with cramping and generalized abdominal pain. His abdominal

pain began the previous night shortly after eating and recurred intermittently. Multiple presentations with similar Z-VAD-FMK datasheet symptoms during his teenage Selleckchem Ixazomib years had failed to identify the cause of his pain. He had no history of previous abdominal surgeries. He was on no medication at the time and denied alcohol or tobacco use. The patient also vomited on the day of presentation with vomitus containing biliary contents. On physical examination, the patient’s vital signs were: pulse, 67 beats/minute; blood pressure, 121/61 mmHg; body temperature, 36.9°C; and respiration rate, 15 breaths/minute. He was well-nourished and alert without cyanosis. His abdomen was not distended, but his bowel sounds

were weak. He exhibited no peritoneal signs; however mild diffuse tenderness to deep palpation was noted. His white blood cell count was 10160 /mm3. Serum biochemistry and liver function test results were within normal limits, except a C-reactive protein level of 4.2 mg/dl. Chest radiography did not reveal any signs of perforation of a hollow viscus. Ultrasonography demonstrated a fluid-filled, distended, small gut loop. No free liquid was visible between the intestinal segments or in the pelvis. Axial contrast-enhanced computed tomography (CT) obtained through the mid-abdomen showed an inverted relationship between the superior mesenteric artery (SMA) and superior mesenteric vein (SMV). The SMV was PLEK2 positioned to the anterior of the SMA (Figure 1A). Opacified small bowel presented almost entirely on the right side (Figure 1B). Upper gastrointestinal tract barium studies revealed that the duodenum ran caudally in a straight line from the first part onwards. The fourth duodenal segment and the normal duodeno-jejunal junction (Treitz ligament) were not developed (Figure 2A). Barium enema revealed that all colon segments with the cecum were found to the left of the spine. The cecum lay on the left side of the abdomen and the ileum entered it from the right (Figure 2B). Figure 1 Contrast enhanced CT of the abdomen.