Erişkin Bir Hastada İntestinal Non-Rotasyon: Olgu Sunumu

Öz

İntestinal non-rotasyon, embriyonik dönemde midgut’un (orta barsağın) normalde gerçekleşmesi gereken 270°’lik saat yönünün tersine rotasyonunun arteria mesenterica superior (AMS) etrafında tamamlanmaması sonucu ortaya çıkan nadir bir konjenital anomalidir. Genellikle yenidoğan veya çocukluk çağında akut klinik bulgularla tanı konulsa da, erişkin yaşta tesadüfen saptanabilir.  Bu olguda, yan ağrısı şikayetiyle başvuran ve laboratuvarda hematuri saptanan 46 yaşındaki erkek hastada, böbrek taşı ön tanısıyla yapılan kontrastsız bilgisayarlı tomografi (BT) incelemesinde intestinal non-rotasyon ile uyumlu anatomik varyasyon saptanmıştır. Ayrıca AMS ile vena mesenterica superior (VMS) inversiyonu izlenmemiş olup, kontrastsız inceleme nedeniyle vasküler değerlendirme sınırlıdır. BT incelemesinde ince barsak sağda, kolon solda yerleşmiş, çekum pelvis düzeyinde ve orta hatta bulunmaktaydı. Bu yerleşim literatürde nadir bildirilen bir varyasyon olarak dikkat çekmektedir. Bu anatomik varyasyonun tanınması, olası komplikasyonların (örneğin midgut volvulusu) önlenmesi ve cerrahi planlamada doğru yönlendirme açısından önemlidir. 

Anahtar Kelimeler

• İntestinal malrotasyon
• İntestinal non-rotasyon
• Arteria mesenterica Superior
• Çekum
• Volvulus

Etik Beyan

No patient photographs or identifying personal information were used in this manuscript.

Intestinal Non-Rotation in an Adult: A Case Report

Öz

Intestinal non-rotation is a rare congenital anomaly resulting from failure of the midgut to complete its normal 270° counterclockwise rotation around the superior mesenteric artery (SMA) during embryonic development. Although it is usually diagnosed in infancy or childhood with acute clinical symptoms, it may also be detected incidentally in adulthood. In this case report, a 46-year-old man who presented with flank pain and hematuria underwent non-contrast computed tomography (CT) with a preliminary diagnosis of kidney stones. CT revealed an anatomical variation consistent with intestinal nonrotation. The small intestine was located on the right side, whereas the colon was located on the left side. The cecum was located at the pelvic level and in the midline, representing an additional variation rarely reported in the literature. No clear inversion between the superior mesenteric artery and superior mesenteric vein (SMV) was observed; however, vascular evaluation was limited because the CT examination was performed without contrast. Recognition of this anatomical variation is important for preventing potential complications, such as midgut volvulus, and for guiding surgical planning.

Anahtar Kelimeler

• Intestinal malrotation
• Intestinal non-rotation
• Superior mesenteric artery
• Cecum
• Intestinal volvulus

Etik Beyan

No patient photographs or identifying personal information were used in this manuscript.

Kaynakça

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