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A case of small intestinal fixation failure.
Kanako Oyanagi1, Yosuke Horii1, Hiroyuki Ishikawa1
1Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan.
BJR Case Reports
|December 11, 2024
Summary
Dysplasia of the ligament of Treitz caused intermittent small intestine malposition, leading to recurrent vomiting and Mallory-Weiss syndrome in a 77-year-old woman. This condition highlights a rare cause of upper gastrointestinal bleeding.
Area of Science:
- Gastroenterology
- Radiology
- Anatomy
Background:
- Mallory-Weiss syndrome, characterized by upper gastrointestinal bleeding, is often associated with forceful vomiting.
- Small intestine malposition can lead to various gastrointestinal complications, but its association with ligament of Treitz dysplasia is rare.
Observation:
- A 77-year-old woman presented with recurrent haematemesis, initially diagnosed as Mallory-Weiss syndrome.
- CT imaging revealed intermittent right-sided deviation of the duodenal-jejunal junction and jejunum, with the third part of the duodenum flexing on the right side of the aorta.
- The abnormal intestinal positioning resolved spontaneously at times but recurred with subsequent episodes of haematemesis.
Findings:
- Initial suspicion of intestinal malrotation was revised to dysplasia of the ligament of Treitz due to the intermittent and spontaneous resolution of malposition.
- Laparotomy confirmed an incompletely fixed ligament of Treitz and a loosely fixed anterior pararenal space, contributing to small bowel mobility.
- The duodenal flexion likely caused obstruction, precipitating vomiting and Mallory-Weiss syndrome.
Implications:
- This case underscores dysplasia of the ligament of Treitz as a potential cause of intermittent small intestine malposition and recurrent upper gastrointestinal bleeding.
- Radiologists and gastroenterologists should consider this rare diagnosis in patients with unexplained, recurrent haematemesis and duodenal positional abnormalities.
- Understanding the anatomical variations and their functional consequences is crucial for accurate diagnosis and management of gastrointestinal disorders.
