Initial laboratory tests showed an INR of 8, hemoglobin of 60 g/L, serum lipase at 1050 UI/L, and C-reactive protein at 250 mg/L A CT scan showed a parietal duodenal hematoma extended from the superior flexure of the duodenum to the duodenojejunal junction
and severe acute pancreatitis with glandular necrosis of the pancreatic gland and retroperitoneal fat necrosis; the modified CT severity index was 10 points.
In such a situation, duodenojejunal junction
is located at the right or back of SMA while cecum is located on the right lower quadrant.
Even in our patient, the location of the duodenojejunal junction
to the right of the vertebral column, the clockwise malrotation of the mesenteric root (whirlpool sign), and the location of the vascular structures on BT were demonstrated in detail.
The procedure was converted to an exploratory laparotomy, which revealed nodular thickening (full thickness) of the small bowel extending from the duodenojejunal junction
to the proximal part of ileum and multiple enlarged lymph nodes in the entire mesentery.
A jejunal conduit was made 20 cm distal to duodenojejunal junction
. Jejunal continuity was restored by end to end jejunal anastomosis.
The Treitz ligament was seen at the duodenojejunal junction
, as normal.
A 13 or 11-F Bilbao Dotter catheter (Indovasive; Biorad Medisys, India) was positioned into the duodenojejunal junction
by using fluoroscopic guidance (Allengers- 525, 40 KW/50 kVA, 500 mA).
Also, the duodenojejunal junction
was located on the right side of the vertebral column.