Rare anomaly unveiled: duodenum inversum, case report with review of literature

Abstract Aim of the study To emphasize the diagnosis and management of duodenum inversum (DI), a rare congenital anomaly in duodenal rotation causing non-specific gastrointestinal symptoms in children. Case descriptions Case 1 A 2-day-old full-term male infant presented with feeding reluctance and bilious vomiting. Imaging excluded malrotation but demonstrated an atypical duodenal configuration consistent with duodenum inversum (DI). He tolerated nasogastric feeds well, with appropriate weight gain at 3- and 6-month follow-up. Case 2 An 11-month-old girl presented with persistent non-bilious vomiting, initially misdiagnosed as refractory gastroesophageal reflux. Subsequent imaging confirmed duodenum inversum. Nasojejunal feeding with a hydrolysed formula led to symptomatic improvement and weight gain. Conclusion Duodenum inversum is a rare congenital anomaly that may be overlooked due to subtle clinical features and a normally positioned duodenojejunal junction. Awareness of its characteristic imaging findings is essential to prevent misdiagnosis and unnecessary interventions. Conservative management is usually sufficient, although surgical intervention may be required in severe or refractory cases.