Expert Management of a Rare Congenital Intestinal Rotation Anomaly at Bombay Gastro & Cancer Institute, Bathinda
A 25-year-old male presented to the emergency department with severe abdominal pain, progressive abdominal distension, repeated vomiting, and inability to pass stool or flatus. Clinical findings were suggestive of an acute intestinal obstruction requiring immediate evaluation.
A contrast-enhanced CT scan revealed an extremely rare congenital anomaly known as Reverse Rotation of the Midgut. The duodenum was seen lying anterior to the Superior Mesenteric Artery (SMA), while the transverse colon was passing posterior to the superior mesenteric vessels. This abnormal anatomy resulted in compression of the transverse colon by the mesenteric vessels, causing complete large bowel obstruction with marked dilatation of the caecum, ascending colon, and proximal transverse colon.
Emergency Surgical Management
The patient underwent emergency exploratory laparotomy performed by Dr. Raman Garg, Consultant Surgical Gastroenterologist, Advanced GI, Laparoscopic & HPB Surgeon at Bombay Gastro & Cancer Institute, Bathinda.
During surgery, the rare congenital rotational anomaly was confirmed. The superior mesenteric vessels were compressing the transverse colon, producing complete obstruction. The obstructed bowel had already developed pressure necrosis with impending perforation, making urgent surgical intervention lifesaving.
The procedure included:
- Derotation of the abnormally rotated intestine.
- Right hemicolectomy to remove the compromised bowel.
- Primary ileotransverse anastomosis to restore intestinal continuity.
The operation was completed successfully with preservation of healthy bowel and restoration of normal intestinal passage.
Postoperative Recovery
The patient's recovery was smooth and uneventful.
- Gradual resumption of oral feeding.
- Normal return of bowel function.
- No major postoperative complications.
- Discharged in satisfactory condition on the 6th postoperative day.
Why This Case Is Important
Reverse rotation of the midgut is one of the rarest forms of intestinal malrotation encountered in adults. Because the transverse colon passes behind the superior mesenteric vessels, it may become compressed, resulting in acute large bowel obstruction, bowel ischemia, or perforation.
Early diagnosis with CT imaging and prompt surgical management are essential to prevent life-threatening complications such as bowel gangrene, perforation, generalized peritonitis, septic shock, and death.
This rare case highlights Dr. Raman Garg's expertise in diagnosing and managing complex gastrointestinal emergencies, congenital intestinal anomalies, and advanced bowel surgery.
Advanced Gastrointestinal Surgery by Dr. Raman Garg
Dr. Raman Garg is a leading Surgical Gastroenterologist in Bathinda, specializing in the treatment of diseases involving the stomach, small intestine, colon, rectum, liver, gallbladder, bile ducts, pancreas, spleen, and abdominal wall. His expertise includes emergency gastrointestinal surgery, intestinal obstruction, colorectal surgery, hepatopancreatobiliary (HPB) surgery, gastrointestinal cancer surgery, advanced laparoscopic surgery, and complex abdominal procedures.
Patients from Bathinda, Punjab, Haryana, Rajasthan, and neighbouring regions trust Dr. Raman Garg for evidence-based treatment of both routine and highly complex gastrointestinal conditions.
Patient: 25-year-old Male
Diagnosis: Reverse Rotation of Midgut with Complete Large Bowel Obstruction and Impending Transverse Colon Perforation
Procedure Performed: Emergency Exploratory Laparotomy, Derotation of the Midgut, Right Hemicolectomy, and Primary Ileotransverse Anastomosis
Operating Surgeon: Dr. Raman Garg, Surgical Gastroenterologist, Advanced GI, Laparoscopic & HPB Surgeon, Bombay Gastro & Cancer Institute, Bathinda
Outcome: Successful emergency surgery with excellent postoperative recovery and discharge on the 6th postoperative day.
About Dr. Raman Garg
Dr. Raman Garg is a Consultant Surgical Gastroenterologist, Advanced GI, Laparoscopic and HPB Surgeon at Bombay Gastro & Cancer Institute, Bathinda. He specializes in gastrointestinal cancer surgery, liver, pancreas and bile duct surgery, colorectal surgery, hernia surgery, upper GI surgery, emergency abdominal surgery, and advanced minimally invasive procedures.
Patient identity has been withheld to maintain confidentiality. This case is shared for educational purposes with appropriate consent and privacy safeguards.
