A cadaveric case of midgut reversed rotation with a common hepatic artery originating from the superior mesenteric artery
摘要
The present study describes a rare case of intestinal malrotation in which the common hepatic artery originated from the superior mesenteric artery, focusing on the morphology of the gastrointestinal tract and vascular distribution. The cadaver was that of an 84-year-old woman donated for research and education; the cause of death was acute renal failure, without a history of gastrointestinal disease or abdominal surgery except for gastrostomy. During anatomical dissection, an abnormal colonic position was identified; the entire gastrointestinal tract was resected. The isolated tract was examined by computed tomography scanning with three-dimensional reconstruction; furthermore, the vessels were dissected and documented using line drawings. In this case, the jejunum and ileum were located on the left side of the abdominal cavity, while the colon was located on the right side. The common hepatic artery originated from the superior mesenteric artery. The common hepatic artery and portal vein ascended anterior to the pancreas and superior part of the duodenum, while the bile duct passed anterior to the superior duodenum and coursed posteriorly around the portal vein. The superior mesenteric artery and vein descended posterior to the horizontal part of the duodenum. The present case suggests clockwise midgut rotation during development, corresponding to the reversed rotation type of intestinal malrotation. The coexistence of this condition with biliary and vascular anomalies has not been previously reported. Recognition of vascular anomalies might be clinically important, particularly during surgical procedures involving the duodenum, pancreas, or biliary tract.