Abstract
The patient was a 13-year-old boy with a past history of repeated episodes of nausea, abdominal pain, and constipation. Since the abdominal pain and nausea episodes had worsened despite conservative medical treatment, the patient was admitted. Abdominal enhanced CT scan showed SMV rotation, the whirlpool sign, and a partially poorly enhanced intestine. Thus, the patient was diagnosed as having a strangulated ileus, and an emergent operation was performed. Adhesion of the ascending colon and transverse colon had resulted in an 180-degree clockwise rotation. After releasing the twisted intestine, the ascending colon and hepatic flexure were found to not be fixed to the right retroperitoneum. After detachment of the adehesion, the patient had a retroperitoneal fixation of the ascending colon and an appendectomy. Intestinal malrotation is rarely seen in older patients. This case highlights the possibility of an intestinal rotation causing repeat nausea and abdominal pain.
