Zawin Joan,  Buyukkaya Ayla

Final Pr. ID: Poster #: CR-016

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. Read More

Authors:  Zawin Joan , Buyukkaya Ayla

Keywords:  Abdominal Imaging, Duodenum, Upper GI Study

Smitthimedhin Anilawan,  Suarez Angela,  Webb Ryan,  Otero Hansel

Final Pr. ID: Poster #: EDU-029

The diagnosis of malrotation is heavily reliant on imaging. Upper GI series remain the gold standard with the normal position of the duodenojejunal junction lateral to the left-sided pedicles of the vertebral body, at the level of the duodenal bulb on frontal views and posterior (retroperitoneal) on lateral views. However, a variety of conditions might influence the position of the duodenojejunal junction, potentially leading to a misdiagnosis of malrotation. Such conditions include gastric over distension, splenomegaly, renal or retroperitoneal tumors, liver transplant, small bowel obstruction, the presence of properly or malpositioned enteric tubes and scoliosis. All of these may cause the duodenojejunal junction to be displaced. We present a series of cases highlighting conditions that mimic malrotation to increase the practicing radiologist awareness and help minimize interpretation errors. Read More

Authors:  Smitthimedhin Anilawan , Suarez Angela , Webb Ryan , Otero Hansel

Keywords:  malrotation, Upper GI study, mimickers