Adult intestinal non-rotation with chronic obstructive symptoms: a rare case report and review of diagnostic laparoscopy and functional reconstruction beyond standard Ladd’s procedure

Intestinal malrotation is rarely diagnosed in adulthood and often presents with non-specific or chronic symptoms. We report a case of a 54-year-old woman presenting with recurrent abdominal pain and obstructive symptoms. Preoperative imaging was inconclusive, and diagnostic laparoscopy revealed non-rotation with abnormal positioning of the bowel and a mobile transverse colon looping around the superior mesenteric artery without volvulus. A standard Ladd procedure was performed, along with a tailored ileosigmoid anastomosis to restore bowel continuity and prevent future volvulus. The postoperative course was uneventful, and the patient remained symptom-free at follow-up. Adult intestinal malrotation may require individualized surgical correction when anatomical variations are encountered intraoperatively. Prompt surgical adaptation can lead to favorable outcomes.