Surgical case reports · 2026
Laparoscopic Fixation of the Proximal Jejunum and Gastrojejunostomy for Small Bowel Volvulus and Recurrent Duodenal Obstruction Caused by Incomplete Fixation and Abnormal Mobility of the Ligament of Treitz: A Case Report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Fukami Tomoyuki, Minato Hiroshi, Kosuga Toshiyuki, Arita Tomohiro, Shiozaki Atsushi
Аннотация
INTRODUCTION: The ligament of Treitz plays a critical role in maintaining the normal anatomical position of the duodenojejunal junction by suspending and fixing the proximal jejunum to the retroperitoneum.
CASE PRESENTATION: A 77-year-old man receiving home-visit medical care after cerebral infarction and cerebral hemorrhage, who had undergone tracheostomy and gastrostomy, was admitted for aspiration pneumonia with respiratory failure. An abdominal CT demonstrated dilatation from the stomach to the proximal duodenum. The third portion of the duodenum coursed caudally without passing between the abdominal aorta and the superior mesenteric artery (SMA). The superior mesenteric vein was located to the right of the SMA at the L2 vertebral level, but to the left of the SMA at the L4 vertebral level, suggesting mesenteric rotation. After conservative decompression therapy, repeat imaging showed spontaneous restoration of normal anatomy. Given the patient's history of recurrent aspiration pneumonia secondary to duodenal obstruction, elective laparoscopic surgery was performed. Intraoperatively, no intestinal malrotation or internal hernia was identified. The duodenojejunal junction showed incomplete retroperitoneal fixation, and the suspensory tissue corresponding to the ligament of Treitz was lax. Laparoscopic fixation of the proximal jejunum to the left retroperitoneum and gastrojejunostomy were performed. The patient was discharged on POD 41. No recurrent obstruction or aspiration events were observed during 9 months of follow-up.
CONCLUSIONS: We report a rare case of recurrent duodenal obstruction with transient small bowel volvulus associated with incomplete fixation and abnormal mobility of the ligament of Treitz. When intermittent rightward displacement of the duodenojejunal junction is observed, this condition should be considered in the differential diagnosis in addition to intestinal malrotation.
CASE PRESENTATION: A 77-year-old man receiving home-visit medical care after cerebral infarction and cerebral hemorrhage, who had undergone tracheostomy and gastrostomy, was admitted for aspiration pneumonia with respiratory failure. An abdominal CT demonstrated dilatation from the stomach to the proximal duodenum. The third portion of the duodenum coursed caudally without passing between the abdominal aorta and the superior mesenteric artery (SMA). The superior mesenteric vein was located to the right of the SMA at the L2 vertebral level, but to the left of the SMA at the L4 vertebral level, suggesting mesenteric rotation. After conservative decompression therapy, repeat imaging showed spontaneous restoration of normal anatomy. Given the patient's history of recurrent aspiration pneumonia secondary to duodenal obstruction, elective laparoscopic surgery was performed. Intraoperatively, no intestinal malrotation or internal hernia was identified. The duodenojejunal junction showed incomplete retroperitoneal fixation, and the suspensory tissue corresponding to the ligament of Treitz was lax. Laparoscopic fixation of the proximal jejunum to the left retroperitoneum and gastrojejunostomy were performed. The patient was discharged on POD 41. No recurrent obstruction or aspiration events were observed during 9 months of follow-up.
CONCLUSIONS: We report a rare case of recurrent duodenal obstruction with transient small bowel volvulus associated with incomplete fixation and abnormal mobility of the ligament of Treitz. When intermittent rightward displacement of the duodenojejunal junction is observed, this condition should be considered in the differential diagnosis in addition to intestinal malrotation.