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


To read more or access our algorithms and calculators, please log in or register.