Intestinal Malrotation in Chronic Form in Adults: A Diagnostic and Management Challenge

Background: Intestinal malrotation in adults is more common in chronic, insidious patterns, reported to be around 88% in the literature, with features ranging from intermittent abdominal pain and vomiting to food intolerance, malabsorption, and motility disorders. This clinical spectrum can be debilitating for the patient in terms of morbidity and mortality, especially in the context of acute presentation in the background of chronic features. Case Presentation: We present a 26-year-old male with a history of over 10 hospital admissions since childhood with intermittent abdominal pain and vomiting labeled as cyclic vomiting syndrome. He was in distress regarding the chronicity of his symptoms and presented with an acute abdomen due to acute small bowel intestinal obstruction. He underwent diagnostic laparoscopy and reduction of internal hernia followed by exploratory laparotomy and division of Ladd’s band and realignment of bowel. Postoperatively, he recovered and recuperated well. Conclusion: Intestinal malrotation should be in the routine differential diagnosis of acute abdomen, especially with the history of nonspecific abdominal symptomatology, so that diagnosis can be made early to prevent morbidity and mortality in this age group.