Adult Acute Appendicitis Complicated by Intestinal Malrotation: A Case Analysis

BACKGROUND Intestinal malrotation (IM) is a rare congenital anomaly resulting from incomplete midgut rotation during embryonic development. Typically, it is diagnosed in infancy due to symptoms such as bilious vomiting, failure to thrive, or signs of bowel obstruction. However, in some cases, it remains undetected until adulthood, when it can present either incidentally or with complications, including volvulus, chronic abdominal pain, or acute bowel obstruction. Although its exact incidence in adults is unclear, studies estimate it to be approximately 0.2% to 0.5%, underscoring its rarity in this age group. As such, adult cases of IM pose a diagnostic challenge and are often discovered unexpectedly during imaging or surgery for unrelated conditions. CASE REPORT A 20-year-old woman with no medical history was admitted to our hospital with persistent mid-abdominal pain. Clinical and sonographic findings suggested acute appendicitis; however, intraoperative exploration revealed an unexpected intestinal malrotation of the non-rotation type. The cecum was in the midline, and the colon was entirely positioned in the left hemi-abdomen, which rendered laparoscopic appendectomy technically challenging. The operation was successfully completed without the need for an additional procedure to correct the malrotation. The postoperative course was uneventful, and the patient was discharged on the second postoperative day in good condition. CONCLUSIONS This case highlights the importance of considering congenital anomalies such as IM in cases of atypically located abdominal structures. Awareness of such anatomical variations is crucial for surgeons so they can adapt intraoperative strategies accordingly and ensure optimal patient outcomes.