BMJ Case Reports 2012; doi:10.1136/bcr-03-2012-6010
  • Unusual association of diseases/symptoms

Unusual presentation of midgut malrotation with incidental nutcracker syndrome in adulthood: case report and literature review

  1. Chiripal B Priyanka3
  1. 1Department of Radiology, NHL Medical College, Ahmedabad, India
  2. 2Department of Radiology, VSGH, Ahmedabad, India
  3. 3Department of Surgery, NHL Medical College, Ahmedabad, India
  1. Correspondence to Dr Panchal N HitenKumar, hitenpanchal1510{at}

Malrotation of the midgut is generally regarded as paediatric pathology with the majority of patients presenting in childhood. The diagnosis is rare in adults, which sometimes results in delayed diagnosis and treatment. We present the case of a 28-year-old woman who presented with vomiting and mild acute pain in the abdomen. CT scan showed abnormal location of the midgut and abnormal relation of the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) and duodenal jejunal flexure, confirming midgut malrotation. Peroperative findings showed the duodenum, small bowel loops located on the right side of the abdomen. The caecum and appendix were located at the midline in the epigastrium with the presence of Ladd's bands. SMA right and anterior to SMV whirled around SMA. Incidentally, the intraoperatively dilated left renal vein was compressed between the SMA and the aorta, which was confirmed retrospectively on CT scan with no symptoms related to the condition.


  • Competing interests None.

  • Patient consent Obtained.

No Related Web Pages

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article