NONROTATED ILEUM WITH FATAL INTESTINAL OBSTRUCTION

The unique anatomic relationship of the terminal ileum and the cecum and ascending colon is the reason for reporting this case of fatal intestinal obstruction. The condition present resembled in a general way the condition found in mobile colon, except that the ascending colon had overridden and become secondarily adherent on a coil of the terminal ileum. Still other coils of the ileum lay to the right side of the ascending colon and cecum. Or, conversely, this part of the ileum failed to rotate and descend, whereas the cecum did so to the usual extent. The dominant features of the anomaly were as follows: About 30 inches from the termination of the ileum in the ileocecal valve, the ileum passed under the posterior parietal peritoneum and ran upward and outward to a point 2 inches below the hepatic angle of the colon. There it turned sharply outward under the colon