Intestinal malrotation in a female adult: Case report and literature review

Adult malrotation is a rare congenital condition in which the intestines do not rotate properly during fetal development. Typically diagnosed in infancy, adult cases can pose unique diagnostic and therapeutic challenges. This report presents a 35-year-old female patient who presented with severe epigastric pain, progressive in the course, associated with recurrent vomiting. An erect abdominal X-ray showed signs of intestinal obstruction. An abdominal computed tomography (CT) scan with intravenous contrast showed a whirl sign of the mesenteric vessels, with the small bowels mainly found on the right side of the abdomen and large bowels on the left side of the abdomen. A laparotomy was done to look inside the abdomen. It revealed bowel malrotation, Ladd's band, and both small and large bowel obstruction with ischemic changes. A pediatric surgeon and a colorectal consultant helped with the surgery. This prompted the execution of Ladd's operation. On the next day, the second check operation, resecting the cecum, and creating an ileocolic double-barrel stoma were done. The patient was discharged home in good general condition after full recovery. Although malrotation is mainly diagnosed in the pediatric population, the diagnosis needs to be kept in mind regularly in case of a history of vague or unexplained abdominal pain, acute or chronic, to avoid catastrophic complications.