WOFAPS 2025 8th World Congress of Pediatric Surgery

Tahira Allahverdieva, Agil Abilov

Azerbaijan Medical University, Department of Pediatric Surgery, Baku

Backround:

Reverse rotation anomaly is a rare form of intestinal malrotation characterized by the transverse colon passing posterior to the superior mesenteric artery (SMA). This aberrant anatomical configuration may result in internal herniation, bowel obstruction, and, rarely, spontaneous fistula formation. Case Presentation: A 10-year-old girl presented with a one-month history of colicky abdominal pain. Abdominal CT showed the transverse colon located posterior to the SMA, with anteriorly displaced small bowel loops, suggestive of reverse rotation anomaly. Diagnostic laparoscopy was initiated and followed by laparotomy due to the complexity of findings. Intraoperatively, the transverse colon was found entrapped between the small intestines and SMA. The small bowel exhibited a volvulus-like twist. Two mesocolic defects were identified: one large and one measuring 3x2 cm. A segment of small intestine had herniated through the smaller defect and formed two gastrojejunial fistulas adherent to the stomach. Both fistulas were dissected and primarily repaired. The bowel was reduced and returned to its anatomical location. The mesocolic defects were closed, and an appendectomy was performed. The postoperative course was uneventful. Conclusion: This rare pediatric case highlights reverse rotation anomaly as an unusual cause of internal herniation, volvulus, and spontaneous gastrojejunial fistulas. To our knowledge, this is the first reported case combining all three complications. Early recognition and timely surgical management are essential to prevent life-threatening outcomes.