Two Cases With Atypical Presentation of Intestinal Malrotation During Adulthood

Intestinal malrotation is often considered a disease of the newborn. It involves the failure of the 270° counterclockwise rotation of the midgut during embryonic development. Patients typically present with symptoms such as bilious vomiting and can further be diagnosed through imaging. The complications of intestinal malrotation include midgut volvulus which can cause ischemia of the intestine. In order to prevent this feared complication and treat malrotation, the four-step Ladd's procedure was developed. Proficiency of the procedure is more common among pediatric surgeons due to the higher incidence rate of malrotation; however, it can occur at any age. Adult presentations are reported to account for only 0.2%-0.5% of all cases of intestinal malrotation. Due to that, adult general surgeons are less likely to encounter the pathology and need to perform a Ladd's procedure. However, with the consequences being so dire, the ability to perform Ladd's procedure remains important in all general surgeons. In this report, we present two cases of intestinal malrotation in adults managed with Ladd's procedure and emphasize the importance with familiarity of both the pathology and procedure.