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Nonrotation of the Intestine: Embryological and Clinical Correlation
Author(s) -
Velavan Sumathilatha Sakthi,
Castellanos Bedia,
Gulfam Nida,
Rich Sushama
Publication year - 2017
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.31.1_supplement.898.10
Subject(s) - anatomy , duodenum , medicine , abdominal cavity , cecum , descending colon , abdomen , large intestine , dissection (medical) , rectum , biology
The Embryology of the gastrointestinal tract involves a well‐orchestrated rotation of midgut to assemble the parts of the gut in the normal anatomical location. The nonrotation is a stage II anomaly and is a very rare variation with an incidence of 1:500. This case is reported for its extreme rarity and its clinical implications that result from the completely altered architecture of the organs in the peritoneal cavity. During routine dissection of the abdomen in an adult female cadaver, abnormal location of the small intestine was noted. A detailed analysis of the intestines was done by tracing from pyloric end of the stomach to the rectum. The vasculature of the abdominal organs, the liver, pancreas, spleen, and the genitourinary tract were dissected to note any variation. The entire small intestine was found to lie on the right side of the abdominal cavity. The duodenum was coiled, located to the right of the superior mesenteric artery and was not crossed by the artery. The ileocecal junction was traced to the hypogastrium where cecum and appendix were situated. The ascending and transverse colon formed a loop on the left half of the abdominal cavity, while the descending colon and sigmoid colon were typically located. A fibrous Ladd's band was found to extend from posterior abdominal wall to the colon, crossing anterior to the duodenum. It held the intestines coiled and had to be released to trace the viscera. The left kidney was normally situated while the right kidney was located close to the midline. The clinical presentation associated with nonrotation of gut ranges from vague intermittent pain to symptoms of acute bowel obstruction, although it may be asymptomatic too. The abnormally located appendix may lead to misdiagnosis of appendicitis. The peritoneal bands may lead to intestinal compression or volvulus. Adequate knowledge of Embryology and resultant variations aid in understanding the abnormal findings during diagnostic interventions prevents surgical complications and also assists in anatomical correction surgery of nonrotation of the intestine.