[Late recognition of intestinal malrotation]

Area of Science:

• Congenital abnormalities
• Surgical diagnosis
• Gastroenterology

Background:

• Intestinal malrotation is a congenital condition resulting from abnormal fetal intestinal rotation.
• It presents with non-specific gastrointestinal symptoms, often leading to diagnostic challenges.

Observation:

• A case of a 20-year-old woman with a long history of abdominal issues and eating disorders is presented.
• Her condition was initially misdiagnosed as psychosomatic until emergency laparotomy revealed intestinal malrotation and necrosis.

Findings:

• The patient's intestinal malrotation was diagnosed late, only after developing intestinal necrosis requiring a right hemicolectomy.
• Diagnostic delays were attributed to non-specific symptoms and potential cognitive biases in clinical reasoning.

Implications:

• Highlights the importance of considering congenital intestinal malrotation in patients with chronic, unexplained abdominal symptoms.
• Emphasizes the need for vigilance in diagnosis, recognizing the overlap between eating disorders and gastrointestinal conditions.
• Suggests that cognitive strategies in diagnosis can sometimes lead to overlooking critical details, necessitating a review of diagnostic approaches.