Malrotation With Midgut Volvulus in an Adolescent Male

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Adolescent Medicine

Background:

• Intestinal malrotation and midgut volvulus are congenital anomalies predominantly diagnosed in neonates.
• Symptoms in infants often include bilious vomiting and abdominal distension, leading to prompt diagnosis.
• Delayed presentation in older children and adolescents is uncommon but can mimic benign conditions.

Purpose of the Study:

• To report an unusual case of high-grade intestinal obstruction due to malrotation and midgut volvulus in an adolescent male.
• To emphasize the diagnostic challenges posed by non-specific symptoms in older patients.
• To highlight the importance of considering surgical etiologies in recurrent abdominal pain and vomiting.

Main Methods:

• Case report presentation.
• Review of clinical presentation, diagnostic workup, and management.
• Discussion of differential diagnoses for abdominal pain and vomiting in adolescents.

Main Results:

• An adolescent male presented with severe abdominal pain and vomiting, initially misdiagnosed as constipation or gastroenteritis.
• High-grade obstruction secondary to malrotation and midgut volvulus was confirmed.
• Significant dehydration was the primary criterion for hospital admission.

Conclusions:

• Malrotation and midgut volvulus should be considered in the differential diagnosis of adolescents presenting with recurrent or severe abdominal pain and vomiting, even without typical neonatal signs.
• Delayed diagnosis can lead to significant morbidity, underscoring the need for heightened clinical suspicion.
• Early surgical intervention is crucial for favorable outcomes in these rare adolescent cases.