Reversed Midgut Rotation in an Adult With Atypical Presentation as Upper Gastrointestinal Bleeding: A Case Report

Reversed midgut rotation is the rarest subtype of intestinal malrotation and is seldom encountered in adult patients. We present the case of a 67-year-old male admitted for a six-month history of upper gastrointestinal bleeding. Contrast-enhanced abdominal computed tomography (CT) demonstrated, as an incidental finding, reversed midgut rotation, characterized by an abnormal position of the duodenum and its relationship with the mesenteric vessels and adjacent structures. Given the absence of obstructive complications, conservative, non-surgical management was deemed appropriate. Upper endoscopy revealed active bleeding, and a hemostatic clip was placed without the need for exploratory surgery. The patient showed adequate clinical response and was discharged with outpatient follow-up. In addition to illustrating a rare case of reversed midgut rotation, this report highlights its atypical clinical and radiologic presentation and emphasizes the importance of CT in recognizing uncommon anatomic variants that may significantly influence clinical and surgical management.