Intestinal neoplasia reveals intestinal malrotation

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CLINICAL IMAGE PEER REVIEWED | OPEN ACCESS
procedure was uneventful, with a successful latero-lateral mechanical anastomosis. The patient was discharged after five days.
Our case is an intestinal non-rotation as it involves the entire midgut with the small bowel located on the right side and the colon on the left side of the peritoneal cavity [3,4]. According to Xiong et al. [5], a right-sided jejunum is a consistent feature of intestinal malrotation, presenting in 98.2% of cases.
Interestingly, an association between malrotation and malignancy has been hypothesized, based on reports such as our own. Genetic factors crucial to the development and rotation of the dorsal mesentery play a role on the physiopathology of malrotation. However, specific mutations and their relation to cancer have not been identified [4]. Moreover, despite the need for further evidence, it is possible that the chronic bowel obstruction observed in some patients may lead to inflammation, and that altered enterohepatic circulation might change bile composition contributing to carcinogenesis [4].
Regardless of symptom presence, coexisting diseases or changes in physical condition can contribute for the development of serious complications, as intestinal occlusion with irreversible ischemia and sepsis [5]. It follows that correct identification of radiographical signs of intestinal malrotation can raise the index of suspicion for its diagnosis and prevent operative morbidity from mis-identification of important anatomical structures.

CONCLUSION
Our images bring attention to intestinal malrotation. An entity with a rare symptomatic presentation in adults, so careful CT image review is warranted. Association with malignancy needs to be investigated. Surgical intervention related to colorectal cancer diagnosis; its place as correction of malrotation in asymptomatic adults should be debated.

Author Contributions
Joana Pimenta -Conception of the work, Design of the work, Acquisition of data, Analysis of data, Interpretation of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved Gabriel Gomes -Conception of the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved Ricardo Escrevente -Analysis of data, Interpretation of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved Emília Duro -Conception of the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved