Yap Chin Harn, Coupland Danielle, Au John, Raju Smita
Royal Adelaide Hospital, Port Rd, Adelaide, Australia.
BJR Case Rep. 2022 Feb 2;8(3):20210144. doi: 10.1259/bjrcr.20210144. eCollection 2022 Sep.
Duodenum inversum is a rare congenital anomaly of unknown aetiology characterised by the proximal duodenum travelling posteriorly and superiorly prior to crossing midline. Clinical presentations include epigastric pain, nausea, and abdominal distension. It can be associated with duodenitis, acute pancreatitis, peptic ulcer disease and functional biliary obstruction. In this case report, we discuss a 77-year-old male who presented with hematemesis and epigastric pain secondary to duodenitis, for which he had a CT scan of the abdomen which demonstrated duodenum inversum. Despite the rarity of the condition and its common omission from differential diagnoses, the ability to recognise duodenum inversum is important for radiologists, especially considering its implications in clinical management. If not diagnosed correctly, it may result in unnecessary hospital admissions, dietary restrictions, and perhaps even unnecessary surgery. In this case, the radiological diagnosis of duodenum inversum using CT allowed for conservative medical management and prevented surgical intervention.
十二指肠反位是一种病因不明的罕见先天性异常，其特征是十二指肠近端在越过中线之前向后上方走行。临床表现包括上腹部疼痛、恶心和腹胀。它可能与十二指肠炎、急性胰腺炎、消化性溃疡疾病和功能性胆管梗阻有关。在本病例报告中，我们讨论了一名77岁男性，他因十二指肠炎出现呕血和上腹部疼痛，为此他进行了腹部CT扫描，结果显示十二指肠反位。尽管这种情况罕见且在鉴别诊断中常被遗漏，但对于放射科医生来说，识别十二指肠反位的能力很重要，尤其是考虑到其对临床管理的影响。如果未正确诊断，可能会导致不必要的住院、饮食限制，甚至可能进行不必要的手术。在本病例中，使用CT对十二指肠反位进行放射学诊断，从而采取了保守的药物治疗并避免了手术干预。
