Abstract
A 24-year-old man who had been admitted four times for the onset of severe upper abdominal pain since the age of 17 was seen at the Emergency Clinic because of the similar symptom in April 2010. After admission, contrast enhanced abdominal CT scan identified an abnormal ligament formed at the base of the mesentery. Intestinal malrotation was diagnosed because of lack of the third part of duodenum and aplasia of the ligament of Treitz. The abnormal ligament was considered to have compressed a branch of the superior mesenteric vein that resulted in abrupt congestion and hypertrophy of the jejunum to cause the abdominal pain. So we selected elective operation. During surgery, the ligament like hypertrophy at the mesentery base was incised so as to keep the freedom of the surroundings of the beginning of the jejunum. Postoperative enhanced abdominal CT scan and upper gastrointestinal fluoroscopy demonstrated disappearance of the abnormal ligament at the mesentery base, absence of edema at the jejunal wall, and the duodenum running the similar course to its physiological one. There have been no symptoms of recurrence, as of two years after the operation. His postoperative course is satisfactory.
In the treatment of patients with recurrent bouts of abdominal pain of unknown origin, a possibility of intestinal malrotation must be kept in mind in performing close examinations, and surgical indication should actively be considered if intestinal malrotation is diagnosed.
