Midgut malrotation first presenting as acute bowel obstruction in adulthood: a case report and literature review

Abstract

Malrotation of the midgut is generally regarded as paediatric pathology with the majority of patients presenting in childhood. The diagnosis is rare in adults, which sometimes leads to delay in diagnosis and treatment. A high index of suspicion is therefore required when dealing with patients of any age group with abdominal symptoms. We present a case of a 55-year old man who presented with an acute abdomen with preoperative computed tomography scan and operative findings confirming midgut rotation. The duodenum, small bowel, caecum and appendix were abnormally located, with the presence of classical Ladd's bands. There was no evidence of intestinal volvulus. The patient underwent an emergency laparotomy with an uneventful postoperative recovery.A review of the literature is presented to highlight the rarity of intestinal malrotation and the controversies surrounding its management in the adult population.

Figure 1

CT scan showing caecum on the left side of the abdomen and terminal ileum entering the caecum from the right side.

Figure 2

CT scan showing inverse relationship of SMA to SMV (a-artery and v-vein).

Figure 3

CT scan showing lack of progression of the duodenum across the aorta and the spines (D-duodenum).

Figure 4

CT scan showing most of the small bowel on the right side of the abdomen.

Figure 5

Photograph showing high caecum and appendix located on the left side of the abdomen.

Figure 6

Graphical representation of the intra-operative findings.