Pancreaticoduodenectomy in the setting of intestinal malrotation

Malrotation is an intestinal gestational disorder which not only affects the positioning of the midgut, but also its vascular supply. While this is generally thought of as a pediatric surgical condition, it can have significant implications for adult surgeries as well. Herein we present a patient with asymptomatic nonrotation of the midgut with a concomitant pancreatic adenocarcinoma. The authors review the modifications necessary to perform a pancreaticoduodenectomy in a nonrotated patient. The review includes a caution and emphasis on an understanding of the vascular anatomic variants.