Adapted retrocolic gastrojejunostomy for gastrectomy in a patient with intestinal malrotation: a case report

Abstract Background Intestinal malrotation (IM) is a rare congenital anomaly in adults that is often asymptomatic and discovered incidentally. Its coexistence with conditions requiring gastrectomy, such as pyloric cicatricial obstruction, presents a significant anatomical challenge in conventional surgical reconstruction. Case presentation A 62-year-old male with a history of gastric ulcer repair presented with epigastric pain and postprandial fullness secondary to pyloric stenosis. Preoperative computed tomography (CT) suggested malrotation, with the superior mesenteric vein positioned ventral to the superior mesenteric artery, and the proximal jejunum originating on the right side. Intraoperative exploration confirmed IM with a mobile ascending colon covering the small intestine. After distal gastrectomy with truncal vagotomy, standard reconstructions (Billroth I, II, or Roux-en-Y) were not feasible. An adapted retrocolic gastrojejunostomy (posterior to the ascending colon) was therefore performed by incising the ascending mesocolon to achieve a tension-free anastomosis. The patient recovered well, and follow-up imaging at 18 days and 2 months confirmed a patent and functional anastomosis without obstruction. Conclusion This case shows that adult IM, although rare, can complicate upper abdominal surgery. When an abnormal anatomy prevents standard reconstruction, retrocolic gastrojejunostomy is a safe, effective, and feasible short-term option. Long-term follow-up is required to confirm its durability.