Acute Midgut Volvulus Due to Intestinal Malrotation and Coexisting Jejunal Diverticulosis in an Elderly Female

Midgut volvulus is an uncommon but critical complication arising from congenital intestinal malrotation. The condition typically presents during infancy, and adult-onset cases, particularly in elderly patients, are rare and often pose a diagnostic challenge due to their nonspecific and variable clinical presentation. We report the case of a mid-hexagenerian female with a known history of hypertension, aortic dissection with coronary artery disease, and chronic kidney disease, who presented with acute-onset colicky abdominal pain, bilious vomiting, and obstipation. Imaging revealed a 180-degree clockwise twisting of the distal ileal loop and the characteristic "whirlpool sign," indicative of volvulus. Emergency exploratory laparotomy confirmed midgut volvulus secondary to malrotation with Ladd's bands and an incidental finding of uninflamed broad-based jejunal diverticula. A Ladd's procedure was successfully performed to release adhesions and bands between the bowel and mesentery. Postoperative ileus complicated the patient's recovery but was resolved with conservative management. In elderly adults, midgut volvulus secondary to intestinal malrotation should be considered in unexplained cases of intestinal obstruction. Progression to bowel ischemia can be prevented by early radiological evaluation and timely surgical management. Jejunal diverticulosis coexistence can be challenging when it is inflamed and perforated; however, in our case, it was a silent spectator not involved in the cause of volvulus.