Malrotation Masquerading as Duodenal Atresia: Case Report and Review of Literature.

Abstract

Intestinal malrotation is a relatively uncommon condition with diverse outcomes. Familiarity with variations in the
presentation of malrotation is imperative as early diagnosis and prompt subsequent surgical intervention are
essential to optimizing outcome. We report a rare case of a 34 weeks preterm neonate who presented with
complaint of non-bilious vomiting since birth. Antenatal ultrasonography showed two dilated cystic structures with
polyhydramnios, suggestive of duodenal atresia. X-ray abdomen standing after birth showed classical 'doublebubble'
appearance. The contrast study was suggestive of dilated stomach and 1st part of duodenum with total
absence of distal bowel gas which suggested possibility of duodenal atresia. Exploratory laparotomy was done
which revealed malrotation of gut with Ladd's band with normal patency of distal bowel. Division of Ladd's band,
derotation of gut, widening of base of mesentery, and appendectomy was done. Child recovered uneventfully and
no recurrence of symptoms on subsequent follow-up for 3 months.