Challenging anatomy: situs inversus, duodenal web, and intestinal malrotation in a neonate.

Introduction: Situs inversus totalis is a rare congenital anomaly, with an estimated incidence of 1 in 10,000 live births worldwide. Its association with intestinal malrotation and a duodenal web is exceptional, with only a few clinical cases reported in the literature.

Clinical case: A full-term neonate presented with signs of intestinal obstruction. Chest and abdominal radiography and ultrasonography led to the diagnosis of situs inversus totalis and duodenal obstruction on the first day of life. An intraoperative contrast study confirmed intestinal malrotation. A Ladd procedure and resection of the duodenal web were performed through a supraumbilical midline approach. The patient had a favorable postoperative course.

Comments: In neonates with situs inversus and intestinal obstruction, we suggest considering intestinal malrotation and a duodenal web as possible concomitant diagnoses. Imaging studies are essential for establishing the surgical strategy.