Intestinal reversed rotation in neonates: A case report and review of the literature

Introduction: Reversed rotation is an extremely rare congenital anomaly that is often associated with intestinal obstruction or midgut volvulus. Although reverse rotation is classified into four types embryologically, there has been no comprehensive review of the mechanisms of the symptoms, imaging findings, or surgical management. Case presentation: A newborn with repeated non-bilious vomiting was admitted to our hospital because of a change to bilious vomiting. Abdominal ultrasonography revealed that the duodenum was in front of the superior mesenteric vessels. An upper gastrointestinal series demonstrated bowel obstruction. Intestinal malrotation was suspected, and surgery was emergently performed. The operative findings revealed reversed intestinal rotation (retroarterial-type). Adhesiolysis and relocation of the small intestine and colon were performed using the Ladd procedure. No recurrence was observed during 2 years of follow-up. Conclusion: A review of the relevant literature on reversed rotation revealed that the retroarterial type was the most common type and that the Ladd procedure was appropriate. Due to the rarity of the condition, the characteristic imaging findings based on the embryological background should be kept in mind to facilitate an adequate diagnosis and treatment in cases of intestinal reversed rotation.