Intestinal duplication in an adult presenting as acute small bowel obstruction with malrotation and volvulus: Case report and updated review of the literature

Introduction: Intestinal malrotation and duplication are rare congenital anomalies that typically present in childhood, but can also occur in adults. Adult presentations are often associated with acute obstructive symptoms, and complications like volvulus and ischemia can rapidly lead to life-threatening outcomes. Early recognition and intervention are essential for ensuring favorable outcomes. Case Report: We report an interesting case of intestinal duplication and malrotation in a 49-year-old male who presented with acute abdominal pain, bilious vomiting, and bloating. Imaging revealed a twisted intestinal segment, initially mimicking a large Meckel’s diverticulum. Surgical exploration uncovered an ischemic segment of ileum with complex torsion and gangrene, necessitating resection and anastomosis. Conclusion: This case highlights the rarity of intestinal malrotation presenting in adulthood, and the severe complications that can result. The rapid progression to ischemia and necrosis emphasizes the need for timely surgical intervention. While Ladd’s procedure is often the treatment of choice, it is not feasible when bowel viability is compromised, as in this case. Adult presentations of intestinal duplication with volvulus are rare, but should be considered in patients with acute obstructive symptoms.