Photoclinic Diagnosis: Malrotation of the Small Bowel with Ladd’s Band

A25-year-old female patient was referred for investigation of the small bowel (SB) with barium transit examination. She had married 3 years before, and did not become pregnant because she was constantly suffering from distressing gass distention, which had led to three laparotomies. These surgical complications, nearly identical in all three, consisted of bowel obstruction due to, as the patient was told by her surgeon in the latest operation, a small piece of hard fecal material. Although 15 cm of the SB was resected, no formal explanation was given; however, it was probably due to bowel wall ischemic necrosis. The patient was thin, from a low socioeconomic class, and appeared normal except for a bat wingshaped purple patch that was apparent on and around the nose; there was no manifestation of systemic dissemination. Her chest X-ray was also normal. Clinical and laboratory analyses were unremarkable.