Case report of intestinal malrotation with midgut volvulus

Abstract

Intestinal malrotation is a congenital anomaly resulting from the failure of the midgut to undergo normal rotation and fixation during embryonic development. This anatomical aberration predisposes patients to midgut volvulus, a life-threatening torsion of the primary mesenteric axis where the bowel twists around the superior mesenteric artery (SMA). If left untreated, this can rapidly progress to catastrophic bowel ischemia and necrosis.The clinical profile, comprehensive diagnostic findings, and emergent surgical management of a rare case of midgut volvulus in an adolescent patient were thoroughly evaluated. Radiological evaluation included an Upper Gastrointestinal (GI) Contrast Series and contrasted abdominal imaging to critically assess anatomical landmarks and confirm the diagnosis prior to operative intervention. Following resuscitation, the patient underwent an emergent open Ladd procedure. Intraoperative findings included the presence of chylous ascites, and the midgut volvulus was carefully untwisted in a counterclockwise direction. Ladd’s bands were systematically divided, the mesenteric base was significantly broadened to prevent recurrence, and a routine inversion appendectomy was performed. The patient had an uneventful postoperative recovery. The Ladd procedure remains the definitive and gold-standard surgical treatment for this critical diagnosis, effectively placing the bowel in a stable state of non-rotation. Clinicians must maintain a high index of suspicion in patients presenting with signs of high intestinal obstruction, intermittent abdominal pain, or unexplained feeding intolerance, regardless of the patient's age.