case_images: PMC10010588_01
case_images: Intraoperative finding showing intestinal non-rotation, with the large bowel- the descending colon, appendix on the left, and small bowel on the right side
case_images: JWACS-13-106-g001.jpg
case_images: PMC10010588_01_JWACS-13-106-g001.jpg
case_images: F1
case_images: The duodenojejunal (DJ) junction was found on the right side and the large bowel sited on the left in a position of complete non-rotation [Figure 1].
case_images: Intraoperative finding showing an atretic gallbladder (blue arrow)
case_images: JWACS-13-106-g002.jpg
case_images: PMC10010588_01_JWACS-13-106-g002.jpg
case_images: F2
case_images: Other intraoperative findings were a non-cirrhotic liver and an atretic extrahepatic biliary tract which included the gallbladder, common hepatic duct, the right and left hepatic ducts [Figure 2].
case_images: Intraoperative photographs showing accessory spleens (blue arrow) and spleen (white arrow)
case_images: JWACS-13-106-g003.jpg
case_images: PMC10010588_01_JWACS-13-106-g003.jpg
case_images: F3
case_images: Polysplenia consisting of four accessory spleens was noted in the left hypochondrium [Figure 3].
case_images: Intraoperative photograph after dissection of the porta hepatis, showing the right and left portal veins (blue arrow), and the fibrous cone transected at porta hepatis (white arrow)
case_images: JWACS-13-106-g004.jpg
case_images: PMC10010588_01_JWACS-13-106-g004.jpg
case_images: F4
case_images: For the latter, the entire extrahepatic biliary tree was mobilized right up to the porta hepatitis, with the proximal end of the tree culminating as a triangular fibrotic cone and excised flush to the liver substance [Figure 4].
case_images: Intraoperative photograph showing portoenterostomy: (A) placement of posterior wall sutures of the Roux-en-Y jejunal loop, (B) after completion of end-to-side portojejunostomy, and (C) after completion of end-to-side jejuno-jejunostomy
case_images: JWACS-13-106-g005.jpg
case_images: PMC10010588_01_JWACS-13-106-g005.jpg
case_images: F5
case_images: Bile drainage was restored by sewing this portion of the roux-en-Y loop to the plate with interrupted 5/0 vicryl sutures [Figure 5].