A Case of Gastric Cancer with Reversed Intestinal Rotation

Abstract

A 74-year-old man visited his local doctor complaining of upper abdominal pain. An upper gastrointestinal endoscopy enabled a diagnosis of gastric cancer ; the patient was therefore referred to our hospital. Abdominal computed tomography (CT) showed the superior mesenteric artery running along the dorsal side of the horizontal portion of the duodenum, along with polysplenia and pancreatic hypoplasia. A CT colonography revealed that the large intestine occupied the right half of the abdominal cavity and that the positions of the ascending and descending colons were reversed. Regarding the vascular construction, the inferior mesenteric artery and gastroduodenal artery were missing and the common hepatic artery was found to branch off from the superior mesenteric artery. Based on these findings, the patient was diagnosed as having reversed intestinal rotation with gastric cancer and treated with total gastric resection with D2 lymph node dissection and Roux-en-Y reconstruction ; no surgery was performed to correct the reversed intestinal rotation. The patient was discharged on postoperative day 18. With the advances in imaging modalities that have occurred in recent years, many useful examination methods other than existing contrast radiography have made it possible to perform detailed investigations even in the preoperative period. In our patient, CT colonography performed in addition to a gastrointestinal series and abdominal CT was useful to diagnose reversed intestinal rotation, and CT angiography was useful to determine the blood vessel distribution pattern.