Gastro-oesophageal reflux associated with duodenum inversum: two case reports and a review of the literature

Duodenum Inversum in a Female: A Rare Clinical Entity Presenting With Right Hypochondrial Pain

Duodenum inversum is a rare congenital anomaly in which the proximal duodenum travels posteriorly and superiorly before crossing the midline, often presenting asymptomatically. Clinical features can include epigastric pain, nausea, and abdominal distension. This case report describes a 35-year-old female who presented with right hypochondrial pain. A CT scan revealed that the third part of the duodenum followed an upward and vertical course, crossing the midline at a higher level than usual, thus confirming the diagnosis of duodenum inversum. Despite the absence of obstruction, conservative medical management was employed to address the symptoms. This case highlights the importance of considering duodenum inversum in the differential diagnosis of right hypochondrial pain and underscores the value of modern imaging techniques in accurate diagnosis. Awareness of this rare condition can facilitate timely and effective management.

Duodenal Volvulus due to Duodenum Inversum

Duodenum inversum, or inverted duodenum, is a rare congenital disorder resulting in an abnormal position of the third and/or fourth portions of the duodenum. Most patients are asymptomatic, but others can experience pain, nausea, vomiting, peptic ulcer disease, pancreatitis, and even intestinal obstruction. In this case, we report a patient who presented with acute abdominal pain and vomiting. He was diagnosed with duodenal volvulus and obstruction due to duodenum inversum. After failing nonoperative management, the patient was successfully treated with surgical resection.

An Anatomic Red Herring Found in the Diagnosis of Functional Vomiting

This report describes the case of a previously healthy 16-year-old patient who initially presented with emesis of unknown etiology that was refractory to standard medical interventions. The initial imaging revealed duodenum inversum, a rare anatomic abnormality that provided additional diagnostic complexity to this case. Though the final diagnosis was found to be functional vomiting, this case gives an instructive review of this rare anatomic abnormality, the significant effects it may cause, and how making a diagnosis of exclusion can be challenged by unusual turns in an otherwise straightforward presentation.