'Head Over Heels' Position of Duodenum-A Unique Congenital Anomaly

Knowledge of congenital anomalies of duodenum and biliary apparatus is useful in radiological diagnosis and surgical procedures of upper abdominal region. We present concurrent variations of duodenum, bile duct and coeliac trunk in this report. The first part of the duodenum descended downwards in front of the head of the pancreas. At the lower end of the head of the pancreas, it ascended upwards along the right border of the head of the pancreas until the first lumbar vertebra. At the level of first lumbar vertebra, it continued to the left as its third part. The third and fourth part passes behind the head, neck and the body of the pancreas (and also behind superior mesenteric vessels). On the left side of the second lumbar vertebra, the duodenum continued as jejunum at the duodenojejunal flexure. The common bile duct coursed down in front of the head of the pancreas, being surrounded by a few pancreatic acini in the lower part of its course. It terminated at the hepatopancreatic ampulla, which opened into the first part of the duodenum. The coeliac trunk passed through the body of the pancreas before it divide into its terminal branches.