Extraordinary rare type of rotational abnormality of the gut revealed in a 6-month-old infant presented with intussusception: a case report.

Intussusception is a common cause of acute abdominal emergency in infants and is usually managed successfully with image-guided enema reduction. Failure of nonoperative reduction should prompt consideration of underlying anatomic abnormalities, including congenital intestinal rotational anomalies. We report a 6-month-old infant who presented with symptoms of intussusception. Abdominal ultrasonography demonstrated a classic target sign consistent with intussusception, without additional specific findings. Contrast enema reduction was unsuccessful and revealed an unexpected bowel configuration. Surgical intervention was subsequently performed. Postoperative imaging demonstrated abnormal bowel positioning consistent with a congenital rotational abnormality, characterized by an atypical, mirror-image distribution of the small bowel and colon that did not conform to classical definitions of malrotation or nonrotation. Recognition of atypical intestinal rotational patterns is clinically relevant in the evaluation of intussusception, particularly when nonoperative management fails. Awareness of these uncommon configurations may aid in accurate interpretation of imaging findings, timely surgical management, and improved characterization of congenital bowel anomalies.