Congenital midgut malrotation presenting as acute duodenal obstruction in an adult—laparoscopic management

Abstract

Background: Intestinal malrotation is a congenital anomaly, wherein the midgut fails to rotate completely or partially during the early embryological developmental phase. The rotation is usually counterclockwise at 270° around the axis of the superior mesenteric artery (SMA). Malrotation is most commonly seen in pediatric population with the majority of patients presenting in their early childhood before the first year of life. Acute duodenal obstruction due to midgut malrotation in an adult is a rare manifestation. Therefore, midgut malrotation should be the differential diagnosis in an adult with bowel obstruction. Case description: We present a case of a 26-year-old male who presented with acute-onset abdominal pain with multiple episodes of bilious vomiting. Contrast-enhanced computed tomography of the abdomen (CECT) revealed intestinal malrotation with all parts of the duodenum (D1–D4) toward the right of the midline. The patient underwent an emergency laparoscopic Ladd’s procedure. Postoperative recovery was uneventful. Conclusion: Adult patients with vague abdominal symptoms should raise a high index of suspicion for malrotation. An early and prompt diagnosis will prevent fatal complications associated with this disease and can be managed laparoscopically by Ladd’s procedure.