Recurrent intestinal volvulus in midgut malrotation causing acute bowel obstruction: A case report

Area of Science:

• Gastroenterology
• Pediatric Surgery
• Surgical Case Reports

Background:

• Intestinal malrotation is a congenital anomaly of bowel development, typically presenting in childhood.
• While adhesions are the common cause of obstruction post-surgery for malrotation, recurrent volvulus is a rare complication.
• Adult presentation of intestinal malrotation is uncommon, but possible.

Purpose of the Study:

• To report a rare case of recurrent small bowel volvulus in an adult with a history of midgut malrotation surgery.
• To highlight the importance of considering recurrent volvulus in patients with prior malrotation repair presenting with obstruction.
• To raise awareness of the potential for delayed complications following Ladd's procedure.

Main Methods:

• Case presentation of a 22-year-old male with recurrent acute bowel obstruction.
• Preoperative diagnosis using computed tomography (CT) scan.
• Surgical findings during emergency laparotomy and subsequent right hemicolectomy.

Main Results:

• The patient presented with acute bowel obstruction and CT findings consistent with midgut malrotation.
• Laparotomy revealed malrotation, absent appendix, abnormal cecal and colonic positioning, small bowel volvulus, and a terminal ileal stricture.
• The patient underwent a limited right hemicolectomy and had an excellent postoperative recovery.

Conclusions:

• Recurrent volvulus can occur years after initial surgery for midgut malrotation, even following a Ladd's procedure.
• A high index of suspicion is necessary for prompt diagnosis and surgical intervention in such cases.
• Early surgical management is vital to prevent bowel ischemia and associated high mortality.