Congenital Intestinal Malrotation With Coexistent Jejunal Diverticula in a Septuagenarian Male: A Case Report

Intestinal malrotation is a congenital anomaly with mostly reported cases in neonates, although, in adults, limited cases have been reported in the literature. However, in adults, prompt recognition is of utmost importance to prevent drastic complications like bowel ischemia and death. We present a rare case of coexistence of congenital intestinal malrotation and jejunal diverticula presenting as a volvulus. We present a case of a 78-year-old male with no comorbidities presenting to the emergency department with an acute abdomen, diagnosed as a case of intestinal obstruction in a virgin abdomen, and treated conservatively. Meanwhile, CT abdomen and pelvis showed volvulus of the small intestine, so the patient was taken for exploratory laparotomy, which revealed the small bowel rotation with a high cecum and a narrow mesentery. Ladd's procedure was performed without any perioperative complications. Few reports of congenital intestinal malrotation in the elderly are presented in the literature. This highlights the importance of evaluating all patients for malrotation if presenting in elderly patients with a virgin acute abdomen to prevent complications like bowel ischemia. Elderly patients presenting with acute intestinal obstruction, if not improving conservatively, should make the clinician think about congenital intestinal malrotation as a differential diagnosis as well, among all other common causes.