Midgut Volvulus with Intestinal Malrotation in an Adult: A Case Report

Background: Intestinal malrotation is a rare congenital disorder characterized by non-rotation or partial rotation of the small bowel around the superior mesenteric arteries during the embryonic stage, resulting in mid-gut volvulus. Approximately 64–90% of patients' symptoms manifest as acute intestinal obstruction due to midgut volvulus before the age of one year, but the presentation in adulthood is infrequent (0.2–0.5%).

Case Report: A 26-year-old lady came to us complaining of intermittent colicky discomfort, vomiting, and constipation for the previous three months. The patient's vitals were stable clinically, with 112/64 mmHg blood pressure, 72 bpm heart rate, 16 rpm respiration rate, 98.4 °F (36.9 °C) temperature, and 100% O2 saturation on room air. The abdomen was mildly distended but had no tenderness or guarding. Abdominal Contrast CT(CECT) revealed a reversal of the relationship between the superior mesenteric vessels, a whirling appearance of the mesentery, and a twisting of the mesentery vessels (whirlpool sign), indicating mid-gut volvulus and intestinal malrotation. Emergency surgical intervention was scheduled for the patient.

Conclusion: Although malrotation is frequent in childhood, symptomatic midgut malrotation can occur in adults with non-specific symptoms. Imaging and a high suspicion level are critical in diagnosing.