Diagnostic Uncertainty in a Case of Heterotaxy Leading to Intestinal Malrotation and Volvulus

TL;DR

A baby with unclear symptoms was diagnosed with a rare condition causing intestinal issues, highlighting the challenges in diagnosing such cases.

Contribution

The case emphasizes the need for increased suspicion of malrotation in neonates with vague symptoms.

Findings

Diagnostic tests showed an inverted stomach and abnormal blood vessels, leading to a diagnosis of malrotation with situs ambiguous.

The child recovered well after surgery, but the case highlights potential delays in diagnosing emergent conditions.

Limited guidelines on diagnostic tests require reliance on surgeon judgment for timely intervention.

Abstract

We present the case of a baby with vomiting and constipation. The diagnostic tests revealed an inverted stomach, the absence of superior mesenteric vein visualization, and an elongated superior mesenteric artery, leading to the diagnosis of malrotation with situs ambiguous. Exploratory laparotomy with the Ladd's procedure was performed, and the child recovered well in the neonatal ICU. The case presented with diagnostic uncertainty in the face of vague symptoms, highlighting the need for a suspicion of malrotation and volvulus in neonates. With limited guidelines on diagnostic tests, this requires reliance on the surgeon's judgment, potentially causing delays in detecting emergent conditions like situs ambiguous leading to malrotation and volvulus.

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