Abstract
A 40-year-old man was admitted because of severe abdominal pain and vomiting. Enhanced CT showed small intestine in the cul-de-sac at the right side of the abdomen and a lack of enhancement of the small intestine. Therefore, an emergency operation was performed under a diagnosis of strangulated intestinal obstruction with an internal hernia. Intraoperativly, a 100-cm length of the proximal portion of the jejunum was found to be twisted clockwise 360° and part of the remaining intestinal loops was located in the retroperitoneal space behind the right side of the mesocolon. This anatomical anomaly without the formation of the Treitz ligament was consistent with a diagnosis of intestinal malrotation. The patient's blood flow recovered quickly after sufficiently expanding the orifice of the hernia and releasing the rotation ; there was no need for intestinal resection.
It is thought that the pathophysiology of malrotation includes paraduodenal hernia, which can occasionally develop strangulation and volvulus. Prompt diagnosis and surgical intervention can avoid intestinal resection.
