Barium contrast-enhanced radiographs are highly sensitive in the diagnosis of malrotation and observing duodenojejunal junction
at the right side of midline-at an abnormal position-is the most specific finding of malrotation [1,2,3].
On supine X-ray of upper GIS barium studies, the observation of duodenojejunal junction
in an abnormal position rather than in its normal position (lateral of the left pedicle of the vertebra and at the same level or above the duodenal bulb) is the most specific finding of malrotation .
In left-sided paraduodenal hernia, MDCT can evidence encapsulated bowel loops at duodenojejunal junction
between the stomach and pancreas to the left of the ligament of Treitz or between the transverse colon and left adrenal gland; often there is a small bowel obstruction with dilated loops and air-fluid levels; mesenteric vessels can be enlarged, stretched, and displaced; the posterior stomach wall can move anteriorly, the duodenojejunal junction
inferomedially, and the transverse colon inferiorly .
Perioperatively, there was a band present constricting the small bowel at approximately 122 cm distal to the duodenojejunal junction
. Two strictures were present in the small bowel: the first one at approximately 228 cm distal to the duodenojejunal junction
and the second on eat almost 45 cm distal to the first one.
A perforated jejunal diverticulum of 2x2 cm was found at mesenteric border about 60 cm from duodenojejunal junction
. Another intact diverticulum was found 30 cm from duodenojejunal junction
Barium follow through examination (Figure 1 and 2) confirmed that the stomach was situated below the right diaphragm followed by a duodenojejunal junction
(ligament of Treitz) located at the left of the spine and crowding of small intestines towards the left side of the abdomen.
At laparotomy, the findings were ileocolic intussusception involving 20 cm of terminal ileum which was gangrenous, intestinal malrotation with duodenojejunal junction
on the right of the midline, midgut volvulus of 180[degrees] in a clockwise direction, and the caecum and proximal third of transverse colon were gangrenous (measuring 25 cm).
One mergency laparotomy patient was found to have intestinal malrotation with duodenojejunal junction
on the right of the midline and 180 mid gut volvulus in clockwise direction.