Clinical & Medical Case Reports

Congenital intestinal malrotation is a complex gastrointestinal anomaly that occurs when there is an aberration in the normal development and rotation of the gut. Though this is commonly seen in children, it can rarely present in adults. The clinical features may be acute or chronic or sometimes patients may even remain asymptomatic throughout their lives. The majority of the patients present within their fi rst birthday but complications due to malrotation such as volvulus and obstruction can occur at any age implying the need to consider this diagnosis when there is a dilemma in identifying the cause of intestinal obstruction in the adult population. We report a case of a 30-year-old gentleman who came to us with a clinical presentation suggestive of acute intestinal obstruction. X-ray abdomen showed dilated small bowel loops. Contrast-Enhanced CT of the abdomen showed evidence of bowel wall enhancement, fl uid-fi lled dilated small bowel loops and the presence of pneumatosis intestinalis. These suggested the possibility of intestinal ischemia. An emergency laparotomy was done and it was found that the intestinal obstruction was due to midgut volvulus resulting from intestinal malrotation. The patient had viable bowel and so we subsequently performed a Ladd's procedure. The patient recovered well and the postoperative period was uneventful. We intend to present this case to highlight the high degree of clinical suspicion needed to diagnose this condition in adults, where an early intervention plays a crucial role in determining the final outcome.