Purpose or Case Report: Case Report
Duodenum inversum is an uncommon congenital anomaly, in which the duodenum ascends to the level of the duodenal bulb, then passes posteriorly before crossing the midline above the pancreas.
This condition is thought to result from the persistence of the dorsal mesentery, leading to increased mobility of the duodenum. It is frequently associated with fixation or positional anomalies of the right kidney, pancreas, and transverse mesocolon.
Diagnosis is typically made via upper gastrointestinal (GI) series or laparoscopy, but may be delayed or overlooked if the configuration of the proximal duodenum is not carefully evaluated.
Although often asymptomatic, when symptoms such as vomiting, abdominal pain, or signs of obstruction are present, accurate diagnosis through imaging is essential for appropriate management. Awareness of this condition can help differentiate it from disorders such as malrotation, duodenal obstruction, or superior mesenteric artery (SMA) syndrome, and prevent potential complications associated with misinterpretation of imaging findings.
Associated conditions can include pancreatitis, gallbladder disease, duodenal ulcer, and, more rarely, gastric ulcer. Many of these symptoms are believed to result from stasis within the duodenal loop.
We present the case of a 1-year-old child with a history of hypoxic ischemic encephalopathy, who underwent upper GI imaging for evaluation of vomiting that had worsened over the past two weeks. On imaging, the first and second portions of the duodenum appeared normal. However, the third portion of the duodenum did not cross the midline, as would be expected. Instead, it ascended on the right side of the spine, posterior and parallel to the descending duodenum, reaching the level of the duodenal bulb. It then completed a transverse course to the left upper abdomen, where the duodenojejunal junction was appropriately located on the left side of the spine, at the level of the duodenal bulb findings consistent with duodenum inversum.
Treatment is primarily medical in the absence of obstruction. In cases where obstruction is attributed to SMA syndrome, transpyloric feeding is considered. Surgical intervention is reserved for cases of obstruction caused by fibrotic bands, in which a partial Ladd’s procedure may be performed.
Methods & Materials:
Results:
Conclusions: