A Rare Twist in the Tale: Midgut Volvulus From Intestinal Non-rotation in an Adult

Abstract

Intestinal malrotation is an inherited condition where the midgut is not properly rotated, and it tends to be noticed in infancy. It becomes evident in later life with unusual abdominal pain and vomiting, which happen due to occasional blockages. Consequently, there is a risk of midgut volvulus and damage to the blood supply of the bowel. For diagnosis, the best method is imaging, especially using a contrast-enhanced upper gastrointestinal series that reveals characteristic signs such as a corkscrew shape and a misplaced duodenojejunal junction. Using ultrasonography and computed tomography (CT) scans, visualization of an unusual relationship between the superior mesenteric vessel and whirlpool sign, as well as abnormal location of the jejunal artery, can be confirmed. Most surgeons use the elective Ladd's procedure for the surgery. When bowel ischemia is found, surgery must be done, and this may result in the difficulties of short bowel syndrome. Given the variable and often subtle clinical presentation, a high index of suspicion for intestinal malrotation is crucial among patients presenting with acute abdomen and intestinal ischemia, necessitating prompt surgical intervention guided by accurate clinical and radiological evaluation to improve patient outcomes.

Keywords: acute midgut volvulus; adult intestinal malrotation; surgical acute abdomen; whirlpool sign; emergency laparotomy.

Figure 1. Erect abdominal X-ray showing multiple dilated bowel loops

Arrows indicate multiple dilated bowel loops.

Figure 2. CECT of the abdomen (axial view)

A: CECT of the abdomen showing a dilated bowel loop. CECT: contrast-enhanced computed tomography

Figure 3. CECT of the abdomen (axial view)

The arrow indicates the dilated bowel loop. CECT: contrast-enhanced computed tomography

Figure 4. Intraoperative image

The arrow points to the cecum.

Figure 5. Intraoperative image

Figure 6. Intraoperative image