Duodenum inversum as a cause of bilious emesis in a teenager: A case report

Introduction

Duodenum inversum is a rare congenital anatomical variant and presents a myriad of clinical challenges. This case presentation highlights a unique case of symptomatic duodenum inversum diagnosed in the second decade of life requiring operative intervention.

Case presentation

We present the case of a thirteen-year-old male who presented with one year of intermittent abdominal pain with associated bilious emesis. Diagnostic work-up included multiple abdominal ultrasounds and abdominal radiographs which only revealed constipation. Despite adequate bowel regimen, patient's symptoms persisted. Duodenum inversum was diagnosed on a fluoroscopic upper gastrointestinal study and the patient was subsequently taken to the operating room to evaluate for concurrent midgut volvulus and malrotation. A diagnostic laparoscopy revealed fibrotic adhesive bands contributing to partial duodenal obstruction. Surgical resection of these bands alleviated the obstruction and resolved the patient's symptoms with no recurrence noted on post-operative follow-up.

Conclusion

In cases of duodenum inversum, recognition through diagnostic tools like fluoroscopic upper gastrointestinal studies is critical. While initial medical management may suffice for mild cases, surgical intervention remains the cornerstone for severe cases, particularly when obstruction is evident, emphasizing the necessity of tailored approaches based on clinical severity.