Fig. 37

Gut malrotation. Barium study of an 8-year-old (a) with intestinal malrotation shows that the duodenum does not cross the midline (arrow). Abdominal CT of an adult patient (b) reveals absence of the 2nd part of the duodenum between the aorta and SMA (asterisks). The duodenum (arrows) crosses anterior to the SM vessels, which show an inverted relationship, with the artery located on the right and the vein on the left side (arrowhead). Incidentally, this patient also had an abnormal course of the portal vein and absence of the inferior vena cava. Abdominal CT of another adult with left flank pain and fever (c, d) shows that the duodenum does not cross the midline (arrow). The small bowel is located predominantly on the right quadrants (asterisks) while the large bowel is located on the left quadrants (arrowheads). On the left flank, an enhancing and thickened, fluid-filled tubular structure (curved arrow) is seen coming out of the cecal pole, which was located on the midline—this was a rare case of an appendicitis on the left quadrants in a patient with nonrotation