2008 (8 months post-surgery), a CT scan revealed an enlargement of the lymph node metastasis with invasion into the portal vein, celiac artery, superior mesenteric artery, duodenum, pancreas, and inferior vena cava.
Reversed rotation is a rare rotation anomaly, where the transverse colon is situated behind the duodenum with the superior mesenteric artery between them [8].
The posterior location of the pancreas, adjacent to the common bile duct, duodenum, celiac plexus, superior mesenteric artery and portal vein, makes diagnosis extremely difficult.
The second portion (descending duodenum) extends between the superior and inferior duodenal flexures in the anterior pararenal space.
Due to the presence of a diverticulum in the third part, unhealthy wound margins, and adjacent superior mesenteric artery, segmental resection of the duodenum was effective.
Du, duodenum; St, stomach; Ao, aorta; SMA, superior mesenteric artery.
Loss of mesenteric fat occurs in the setting of significant or rapid weight loss, allowing the duodenum to be compressed between the superior mesenteric artery and the spine, leading to symptoms of small bowel or gastric obstruction (Fig. 10) [29, 29].
However, we believe that it is insufficient to evaluate only cholangiograms and, diagnostic potential of endoscopy visualizing the exact site or origin of biliary drainage into the duodenum or stomach seems to be superior to operative cholangiograms.
On CT, malrotation is diagnosed when the duodenum is not visible between the aorta and the superior mesenteric artery and the superior mesenteric artery (SMA) is located to the right of the superior mesenteric vein.
SMA Syndrome is characterised by compression of the duodenum between the abdominal aorta and the superior mesenteric artery, and may when congenital result from a short suspensory muscle.
