Published: 2020-09-23

A rare presentation of midgut malrotation as an acute intestinal obstruction and perforation in an adult

Praveen Gnanadev, Rohit Krishnappa, Hariprasad Ramachandra Naidu Taluru, Gopal Subbaiah, Gautham Mungaravalli Vasantha, Dilip Kumar Sanjeevi Nagaraj, Geethu Damodaran


Midgut malrotation is a congenital anomaly seen usually in childhood. Its presentation as an acute intestinal obstruction is extremely rare in adults usually identified intra operatively. A high index of suspicion is always required when dealing with any case of acute intestinal obstruction. We report a case of young adult who presented with symptoms of acute intestinal obstruction and was diagnosed intra-operatively as cecal volvulus with impending perforation caused by midgut malrotation. Malrotation of the intestinal tract is seen due to aberrant embryology. The presentation of intestinal malrotation in adults is very rare. Contrast enhanced Computed tomography (CT) can show the abnormal anatomy clearly. Anomalies like midgut malrotation can present as an operative dilemma and awareness regarding these conditions can help surgeons deal with these conditions.


Midgut malrotation, Acute intestinal obstruction, Cecal volvulus, Perforation

Full Text:



Torres AM, Ziegler MM. Malrotation of the intestine. World J Surg. 1993;17:326-31.

Von Flue M, Herzog U, Ackermann C, Tondelli P, Harder F. Acute and chronic presentation of intestinal non-rotation in adult. Dis Colon Rectum. 1994;37:192-8.

Sahu SK, Raghuvanshi S, Sanchan PK. Adult malrotation presenting as midgut volvulus: case report. J Surgical Arts. 2012;5:18-21.

Pinto A, Di Raimondo D, Tuttolomondo A, Fernandez P, Caronia A, Lagalla R, et al. An atypical clinical presentation of acute appendicitis in a young man with midgut malrotation. Radiography. 2007;13(2):164-8.

Luca S, Pemberton JH. Embryology and anatomy of the colon. Shackelford’s Surgery of the alimentary tract. 6th edition. 1862.

Fukuya T, Brown BP, Lu CC. Midgut volvulus as a complication of intestinal malrotation in adults. Digestive Dis Sci. 1993;38(3):438-44.

Torres MA, Ziegler MM. Malrotation of the intestine. World Journal of Surgery. 1993;17:326-31.

Wang C, Welch C. Anomalies of intestinal rotation in adolescents and adults. Surgery. 1963;54:839-55.

Dietz DW, Walsh RM, Grundfest-Broniatowski S, Lavery IC, Fazio VW, Vogt DP. Intestinal Malrotation: a rare but important cause of bowel obstruction in adults. Dis Colon Rectum. 2002;45(10):1381-86.

Ladd WE. Surgical diseases of the alimentary tract in infants. N Engl J Med. 1936;215:705-8.

Fu T, Tong WD, He YJ, Wen YY, Luo DL, Liu BH. Surgical management of intestinal malrotation in adults. World Journal of Surgery. 2007;31:1797-1803.

Matzke GM, Dozois EJ, Larson DW, Moir CR. Surgical management of intestinal malrotation in adults: comparative results for open and laparoscopic Ladd procedures. SurgEndosc. 2005;19:1416-19.

Moldrem AW, Papaconstantinou H, Broker H, Megison S, Jeyarajah DR. Late presentation of intestinal malrotation: an argument for elective repair. World J Surg. 2008;32:1426-31.

Gamblin TC, Stephens RE, Johnson RK, Rothwell M. Adult malrotation: A case report and review of the literature. Current Surgery. 2003;60(5):517-20.

Pickhardt PJ, Bhalla S. Intestinal malrotation in adolescents and adults: spectrum of clinical and imaging features. American Journal of Radiology. 2002;179:1429-35.

Nichols DM, Li DK. Superior mesenteric vein rotation: a CT sign of midgut malrotation. Am J Roentgenol. 1983;141:707-8.

Fisher JK. Computer tomographic diagnosis of volvulus in intestinal malrotation. Radiology. 1981;140:145-6.