An adolescent or adult with previously undiagnosed intestinal nonrotation may present with clinical findings that often may be misinterpreted. Making the diagnosis usually requires a high level of suspicion.
Clinical findings:
(1) intermittent episodes of unexplained abdominal pain or colic
(2) recurrent episodes of partial bowel obstruction with distention and vomiting that have resolved spontaneously
(3) occurrence of flatus and/or blood-stained stools shortly after pain resolves
Some patients will progress to complete bowel obstruction.
Imaging studies:
(1) A flat plate of the abdomen will show the colon lying on the left side of the abdomen.
(2) A barium swallow will show small bowel lying entirely on the right side of the abdomen.
Differential diagnosis (and diagnostic pitfalls):
(1) malingering
(2) psychiatric disorder
(3) irritable bowel syndrome
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