Anatomical Correction of Adult Intestinal Malrotation Using Kareem's Procedure: A Case Report.
Waheeb Radman Al-Kubati, Mansour Mohammed Al-Hameli, Nardeen Alqousi et al.
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Case in brief
A 26-year-old woman presented with sudden severe colicky central abdominal pain, non-bilious vomiting, and complete constipation; she had experienced a similar self-limited episode a month earlier. Contrast-enhanced CT showed an inverted SMA/SMV relationship, right-sided clustering of small-bowel loops, and an abnormally positioned duodenojejunal junction, consistent with intestinal malrotation and acute complications. She underwent anatomical correction with Kareem’s procedure. At follow-up, her pain had resolved, and CT showed normalization of the SMA/SMV relationship and bowel positioning, including the cecum in the right iliac fossa.
What made this case unusual
The case illustrates adult intestinal malrotation presenting with acute obstructive symptoms after a prior self-limited episode, with CT demonstrating several characteristic positional abnormalities.
Diagnostic / clinical pearl
Consider intestinal malrotation in adults with unexplained abdominal pain or features of obstruction; CT findings such as an inverted SMA/SMV relationship and abnormal bowel positioning can support the diagnosis.