{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T08:27:28Z","timestamp":1775032048615,"version":"3.50.1"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intestinal malrotation (IM) is a developmental anomaly of the intestine characterized by abnormal rotation of the midgut around the superior mesenteric artery (SMA) axis. This condition is more prevalent in children under 1 year of age. Superior mesenteric artery syndrome (SMAS) is a rare disorder caused by a decreased angle between the abdominal aorta (AA) and the SMA, leading to compression of the horizontal segment of the duodenum. Both conditions present with symptoms such as abdominal pain and vomiting. A preoperative diagnosis that relies exclusively on clinical manifestations and imaging examinations may lead to misdiagnosis or overlooking of the condition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case description<\/jats:title>\n                    <jats:p>A 13-year-old female patient was admitted to the hospital with a 12-h history of abdominal pain accompanied by vomiting and reduced passage of flatus. Physical examination revealed tenderness in the upper abdomen and periumbilical region, along with diminished bowel sounds. Preoperative imaging revealed a \u201cvortex sign\u201d and a reduced angle between AA and SMA (10\u00b0). During surgery, a 270\u00b0 reverse rotation of the intestine was observed. The angle between the AA and SMA was further reduced, and SMA was positioned in close proximity to the duodenum. Obstruction of the distal descending duodenum was also observed. The patient was diagnosed with reverse intestinal malrotation (RIM) combined with SMAS. The patient underwent Ladd's procedure and duodenojejunostomy and recovered completely after the operation. No abnormalities were observed during the follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients presenting with IM accompanied by abdominal pain and vomiting, clinicians should consider the possibility of RIM and SMAS. A comprehensive preoperative evaluation is essential to exclude complex gastrointestinal malformations, thereby optimizing the surgical strategy and enhancing postoperative recovery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1775767","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T05:39:17Z","timestamp":1775021957000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Intestinal malrotation combined with superior mesenteric artery syndrome: a case report"],"prefix":"10.3389","volume":"14","author":[{"given":"Ning","family":"An","sequence":"first","affiliation":[{"name":"Department of Pediatrics Surgery, Linyi People\u2019s Hospital, Affiliated Hospital of Shandong Second Medical University","place":["Linyi, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liangfu","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Surgery, Linyi People\u2019s Hospital, Affiliated Hospital of Shandong Second Medical University","place":["Linyi, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xingyun","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Surgery, Linyi People\u2019s Hospital, Affiliated Hospital of Shandong Second Medical University","place":["Linyi, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guangping","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Surgery, Linyi People\u2019s Hospital, Affiliated Hospital of Shandong Second Medical University","place":["Linyi, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guoxiu","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Surgery, Linyi People\u2019s Hospital, Affiliated Hospital of Shandong Second Medical University","place":["Linyi, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Surgery, Linyi People\u2019s Hospital, Affiliated Hospital of Shandong Second Medical University","place":["Linyi, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rongpeng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Surgery, Linyi People\u2019s Hospital, Affiliated Hospital of Shandong Second Medical University","place":["Linyi, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yiming","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Surgery, Linyi People\u2019s Hospital, Affiliated Hospital of Shandong Second Medical University","place":["Linyi, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Surgery, Linyi People\u2019s Hospital, Affiliated Hospital of Shandong Second Medical University","place":["Linyi, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1390856","DOI":"10.3389\/fped.2024.1390856","article-title":"Identification and treatment of intestinal malrotation with midgut volvulus in childhood: a multicenter retrospective study","volume":"12","author":"Yang","year":"2024","journal-title":"Front Pediatr"},{"key":"B2","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1007\/s00383-024-05796-9","article-title":"Clinical management of intestinal malrotation in different age groups","volume":"40","author":"Bostanc\u0131","year":"2024","journal-title":"Pediatr Surg Int"},{"key":"B3","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/j.ajem.2024.06.012","article-title":"High risk and low incidence diseases: pediatric digestive volvulus","volume":"82","author":"Long","year":"2024","journal-title":"Am J Emerg Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1053\/j.sempedsurg.2011.03.005","article-title":"Embryology of the midgut","volume":"20","author":"Metzger","year":"2011","journal-title":"Semin Pediatr Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1016\/j.ijscr.2017.03.018","article-title":"Superior mesenteric artery syndrome: a diagnosis to be kept in mind (case report and literature review)","volume":"34","author":"Salem","year":"2017","journal-title":"Int J Surg Case Rep"},{"key":"B6","doi-asserted-by":"publisher","first-page":"997","DOI":"10.1007\/s11605-018-3984-6","article-title":"Superior mesenteric artery syndrome: a prospective study in a single institution","volume":"23","author":"Ganss","year":"2019","journal-title":"J Gastrointest Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2006","DOI":"10.1016\/j.jand.2022.07.006","article-title":"Adapting the screening tool for the assessment of malnutrition in pediatrics to the electronic health record","volume":"122","author":"Reed","year":"2022","journal-title":"J Acad Nutr Diet"},{"key":"B8","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.semcdb.2018.08.009","article-title":"The development of the dorsal mesentery in human embryos and fetuses","volume":"92","author":"Hikspoors","year":"2019","journal-title":"Semin Cell Dev Biol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1016\/j.jpedsurg.2023.11.020","article-title":"Notable clinical differences between neonatal and post-neonatal intestinal malrotation: a multicenter review in Southern Japan","volume":"59","author":"Kedoin","year":"2024","journal-title":"J Pediatr Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.pedneo.2023.11.009","article-title":"Twenty years\u2019 experience of midgut malrotation and volvulus in a tertiary center in Northern Taiwan: a retrospective study","volume":"66","author":"Tseng","year":"2025","journal-title":"Pediatr Neonatol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1007\/s00383-019-04454-9","article-title":"The identification and treatment of intestinal malrotation in older children","volume":"35","author":"Dekonenko","year":"2019","journal-title":"Pediatr Surg Int"},{"key":"B12","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1007\/s13304-023-01559-8","article-title":"Diagnostic accuracy of upper gastrointestinal series in children with suspected intestinal malrotation","volume":"76","author":"Girolamo","year":"2024","journal-title":"Updates Surg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e240177","DOI":"10.1148\/rg.240177","article-title":"Imaging review of intestinal malrotation and midgut volvulus","volume":"45","author":"Yousef","year":"2025","journal-title":"Radiographics"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1079192","DOI":"10.1155\/2017\/1079192","article-title":"Utility of the CT scan in diagnosing midgut volvulus in patients with chronic abdominal pain","volume":"2017","author":"Shahverdi","year":"2017","journal-title":"Case Rep Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1097\/sla.0000000000005072","article-title":"Five hundred patients with gut malrotation: thirty years of experience with the introduction of a new surgical procedure","volume":"274","author":"Abu-Elmagd","year":"2021","journal-title":"Ann Surg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1056\/NEJM193610152151604","article-title":"Surgical diseases of the alimentary tract in infants","volume":"215","author":"LADD","year":"1936","journal-title":"N Engl J Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.1007\/bf00189001","article-title":"Laparoscopic repair of acute volvulus in a neonate with malrotation","volume":"9","author":"van der Zee","year":"1995","journal-title":"Surg Endosc"},{"key":"B18","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1089\/lap.2021.0436","article-title":"Laparoscopic versus open Ladd\u2019s procedure for intestinal malrotation in infants and children: a systematic review and meta-analysis","volume":"32","author":"Zhang","year":"2022","journal-title":"J Laparoendosc Adv Surg Tech A"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2777","DOI":"10.1016\/j.jpedsurg.2020.08.014","article-title":"Outcomes of laparoscopic and open surgical treatment of intestinal malrotation in children","volume":"55","author":"Scalabre","year":"2020","journal-title":"J Pediatr Surg"},{"key":"B20","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1055\/s-0043-1764239","article-title":"Intestinal malrotation in children: clinical presentation and outcomes","volume":"34","author":"Salehi Karlsl\u00e4tt","year":"2024","journal-title":"Eur J Pediatr Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1186\/s13256-017-1423-z","article-title":"Neonatal intestinal obstruction associated with situs inversus totalis: two case reports and a review of the literature","volume":"11","author":"Gupta","year":"2017","journal-title":"J Med Case Rep"},{"key":"B22","doi-asserted-by":"publisher","first-page":"108881","DOI":"10.1016\/j.ijscr.2023.108881","article-title":"Reversed midgut rotation revealed by cecal volvulus in the elderly: a case report","volume":"111","author":"Landolsi","year":"2023","journal-title":"Int J Surg Case Rep"},{"key":"B23","doi-asserted-by":"publisher","first-page":"106700","DOI":"10.4240\/wjgs.v17.i7.106700","article-title":"Congenital midgut reverse transposition with herniation of the jejunum into a malformed omentum: a case report","volume":"17","author":"Wang","year":"2025","journal-title":"World J Gastrointest Surg"},{"key":"B24","doi-asserted-by":"publisher","first-page":"e6074","DOI":"10.7759\/cureus.6074","article-title":"A case of Wilkie\u2019s syndrome: consideration of alternative diagnosis in the setting of chronic abdominal pain","volume":"11","author":"Adame","year":"2019","journal-title":"Cureus"},{"key":"B25","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1159\/000102097","article-title":"Recalling superior mesenteric artery syndrome","volume":"24","author":"Welsch","year":"2007","journal-title":"Dig Surg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"541","DOI":"10.3390\/nu16040541","article-title":"Superior mesenteric artery syndrome in anorexia nervosa: a case report and a systematic revision of the literature","volume":"16","author":"Bozzola","year":"2024","journal-title":"Nutrients"},{"key":"B27","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1056\/NEJMicm2213146","article-title":"Superior mesenteric artery syndrome","volume":"389","author":"Kerdiles","year":"2023","journal-title":"N Engl J Med"},{"key":"B28","doi-asserted-by":"publisher","first-page":"2945","DOI":"10.1016\/j.mayocp.2021.09.017","article-title":"Superior mesenteric artery syndrome","volume":"96","author":"Gibson","year":"2021","journal-title":"Mayo Clin Proc"},{"key":"B29","doi-asserted-by":"publisher","first-page":"rjz054","DOI":"10.1093\/jscr\/rjz054","article-title":"Superior mesenteric artery syndrome: a rare case of upper gastrointestinal obstruction","volume":"2019","author":"Chrysikos","year":"2019","journal-title":"J Surg Case Rep"},{"key":"B30","doi-asserted-by":"publisher","first-page":"2387524","DOI":"10.1080\/08941939.2024.2387524","article-title":"Laparoscopic surgery for superior mesenteric artery syndrome","volume":"37","author":"Lu","year":"2024","journal-title":"J Invest Surg"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ijscr.2014.11.063","article-title":"Malrotation of gut with superior mesenteric artery syndrome and multiple jejunal diverticula presenting as acute intestinal obstruction in 6th decade: a rare case report","author":"Saxena","year":"2015","journal-title":"Int J Surg Case Rep"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1136\/bcr.08.2008.0631","article-title":"Atypical midgut malrotation presenting as chronic bowel obstruction in the eighth decade","volume":"2009","author":"Horwood","year":"2009","journal-title":"BMJ Case Rep"},{"key":"B33","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1186\/s13256-018-1802-0","article-title":"Novel variant of reversed midgut rotation\u2014retro-arterial proximal jejunum and transverse colon: a case report and review of the literature","volume":"12","author":"Deniffel","year":"2018","journal-title":"J Med Case Rep"},{"key":"B34","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1002\/jpn3.12178","article-title":"Persistent and newly developed gastrointestinal symptoms after surgery for intestinal malrotation in children: dysmotility or disorders of gut and brain interaction?","volume":"78","author":"Patel","year":"2024","journal-title":"J Pediatr Gastroenterol Nutr"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1775767\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T05:39:19Z","timestamp":1775021959000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1775767\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":34,"alternative-id":["10.3389\/fped.2026.1775767"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1775767","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]},"article-number":"1775767"}}