Gastric Cancer Presenting with Intestinal Malrotation Wrapped by Peritoneum—A Case Report—

Abstract

A 75-year-old woman presented with abdominal pain. Esophagogastroduodenoscopy was performed, and gastric cancer was diagnosed. The transverse part of the duodenum was not identified on preoperative computed tomography (CT), suggesting intestinal malrotation. On laparotomy, bowel was seen in the midgut area wrapped by a peritoneal-like sac. This tissue was excised and submitted as a pathological specimen. The patient's postoperative course was uneventful. Histopathologically, the peritoneal-like sac covering the small intestine was diagnosed as peritoneum. Congenital midgut malrotation is an uncommon entity in the adult population. The feature of this case was that the small intestine was wrapped by the peritoneal-like sac, and this sac was histopathologically confirmed to be peritoneum. No similar case, except for one reported by Tsuyukubo, could be identified. However, the mechanism by which the small intestine with malrotation was wrapped by the peritoneum has not been elucidated. As discussed by Tsuyukubo, the process of midgut herniation into the umbilical cord during the antenatal period could be one possible explanation.