Late-onset midgut volvulus 8 years following a neonatal omphalocele repair: a case report and review

Omphalocele is a congenital abdominal wall defect. It is frequently associated to other anomalies such us intestinal malrotation, though this is frequently underdiagnosed. We report a rare case of an 8-year-old boy with a history of neonatal surgery for a small type I omphalocele. The child was asymptomatic since his neonatal primary repair. Presented acutely with signs of intestinal obstruction. Imaging suggested high-grade obstruction, and emergency laparotomy revealed a midgut volvulus caused by tight Ladd's bands around a narrowed mesenteric base. A Ladd's procedure was performed, including detorsion, band division, bowel repositioning, and prophylactic appendectomy. The patient recovered uneventfully. This case highlights the potential for late-onset volvulus in patients with prior omphalocele repair, underlining the importance of long-term follow-up and a high index of suspicion in acute presentations. It also raises considerations regarding the prophylactic role of Ladd's procedure during initial repair, especially in settings equipped for ongoing surveillance.