Intestinal Malrotation Through Acute Obstructive Abdomen in an Adolescent From Northeastern Brazil: A Case Report

Intestinal malrotation is a congenital anomaly of the midgut resulting from abnormal embryonic rotation. Although predominantly a neonatal diagnosis, it is an extremely rare, isolated finding in adolescents, often presenting with nonspecific symptoms that lead to diagnostic delays and increased morbidity. We report a 17-year-old male presenting with acute abdominal pain, distension, and vomiting. Diagnosis was established via contrast-enhanced computed tomography (CT), which identified spiral rotation of mesenteric vessels and colonic displacement. The patient initially underwent a laparoscopic Ladd's procedure; however, postoperative complications involving duodenal stenosis and recurrent obstruction required a conversion to a Billroth II gastrojejunostomy with a Braun anastomosis. This case highlights that while the Ladd's procedure remains the surgical standard, the management of malrotation in older patients presents unique challenges compared to neonates. Unlike pediatric cases often associated with other malformations, adolescent presentation is typically isolated and insidious, making contrast-enhanced CT essential for identifying the "whirlpool sign" and avoiding misdiagnosis. Furthermore, this report underscores that chronic inflammation or recurrence in adults may demand surgical strategies beyond the standard procedure. In complex scenarios with recurrent obstruction, reconstructive techniques such as the Billroth II gastrojejunostomy with Braun anastomosis or Roux-en-Y gastric bypass are effective alternatives to prevent alkaline gastritis and ensure long-term symptom resolution.