An often-forgotten diagnosis: Midgut malrotation and volvulus in an adult

Abstract

Intestinal malrotation is a rare congenital abnormality that typically presents in the neonatal period or within the first year of life. However, it is exceedingly rare for this condition to persist without symptoms or go undiagnosed until adulthood. Case Report: A 70-year-old man sought medical assistance due to severe abdominal pain, nausea, vomiting, and bloating. Despite experiencing intermittent abdominal pain for 15 years, he had never undergone any abdominal procedure. Upon examination, no tenderness or distension was observed, but an abdominal radiograph indicated a distended small bowel. Subsequent contrast-enhanced abdominal computed tomography (CT) scan confirmed midgut malrotation with volvulus, showing a whirlpool sign. The patient received symptomatic treatment and was discharged for an elective Ladd's procedure. Conclusion: Intestinal malrotation is often missed in adults with non-specific abdominal symptoms, leading to delayed diagnosis. This emphasizes the importance of considering it in the differential diagnosis of suspected small bowel obstruction.

Keywords

• Midgut malrotation
• midgut volvulus
• intestinal malrotation
• adult

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