Midgut Volvulus Secondary to Intestinal Malrotation in an 11-Year-Old Child With Preserved Bowel Viability: A Rare...

Midgut volvulus is a life-threatening surgical emergency that most commonly presents during infancy, whereas delayed presentation in older children is uncommon and can be diagnostically challenging. An 11-year-old boy presented with acute abdominal pain, bilious vomiting, abdominal distension, and obstipation of two days' duration after four prior episodes of subacute intestinal obstruction over three years that had been managed conservatively. Contrast-enhanced computed tomography of the abdomen demonstrated the classical whirlpool sign, suggestive of midgut volvulus secondary to intestinal malrotation. Emergency exploratory laparotomy confirmed incomplete intestinal malrotation with a 180-degree clockwise midgut volvulus around a narrow mesenteric base. The bowel was congested but fully viable, without ischemia or necrosis. The patient underwent Ladd's procedure with counterclockwise derotation, division of Ladd's bands, widening of the mesenteric base, and bowel repositioning. Caecopexy and sigmoidopexy were also performed because of marked intraoperative mobility of the caecum and redundant sigmoid colon. Recovery was uneventful, and the patient was discharged on postoperative day 7. This case highlights the need to consider malrotation with volvulus beyond infancy in children with recurrent bilious vomiting or episodic intestinal obstruction, because early imaging and timely surgery can preserve bowel viability.