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CT Abd Malrotation

Technique: Helical CT of the abdomen/pelvis after administration of IV and oral contrast. Standard 5 mm axial images were obtained with coronal and sagittal reformations. Renal delay images were also obtained. Findings: The lungs are without evidence of mass, consolidation, or pleural effusion. Limited views of the heart are unremarkable. The liver, pancreas, spleen, adrenals, and kidneys demonstrate normal morphology and enhancement without mass lesions. Incidentally noted is a long inferior projection of the right hepatic lobe extending along the right paracolic gutter, consistent with a Riedel's lobe. The stomach is in the expected position within the left upper abdomen. The normal leftward duodenal sweep is not well visualized. It appears that the duodenum continues rightward after its association with the pancreatic head and bile duct. The normal configuration of bowel about ligament of Treitz is not appreciated in this study. The majority of the jejunum is located in the right abdomen. There is abnormal rightward deviation of the SMA. Following the course of the SMA further, there is a C curvature of the SMA, consistent with a history of malrotation. Also, the proximal SMA is right of the SMV. The colon is normal in course and caliber. Enteric contrast extends to the splenic flexure. There is no evidence of bowel obstruction. The hollow viscera are without evidence for wall thickening, mass, or obstruction. There is no evidence of free fluid or free air in the peritoneal cavity. The bladder is normal. The remainder of the soft tissues and osseous structures are unremarkable. IMPRESSION: 1. Multiple abdominal anatomical anomalies as described above, all consistent with congenital gut malrotation. 2. No evidence of bowel obstruction or acute intra-abdominal pathology.